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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2015; 21(37): 10542-10552
Published online Oct 7, 2015. doi: 10.3748/wjg.v21.i37.10542
Endoscopic management of gastrointestinal perforations, leaks and fistulas
Pawel Rogalski, Jaroslaw Daniluk, Andrzej Baniukiewicz, Eugeniusz Wroblewski, Andrzej Dabrowski
Pawel Rogalski, Jaroslaw Daniluk, Andrzej Baniukiewicz, Eugeniusz Wroblewski, Andrzej Dabrowski, Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland
Author contributions: Rogalski P, Daniluk J, Baniukiewicz A, Wroblewski E and Dabrowski A contributed equally to this work; Rogalski P, Daniluk J, Baniukiewicz A, Wroblewski E and Dabrowski A wrote the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pawel Rogalski, MD, Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, M.Sklodowska-Curie 24A, 15-276 Bialystok, Poland. progalsky@gmail.com
Telephone: +48-85-7468234 Fax: +48-85-7468506
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: June 2, 2015
Revised: July 1, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: October 7, 2015
Processing time: 153 Days and 11.8 Hours
Abstract

Gastrointestinal perforations, leaks and fistulas may be serious and life-threatening. The increasing number of endoscopic procedures with a high risk of perforation and the increasing incidence of leakage associated with bariatric operations call for a minimally invasive treatment for these complications. The therapeutic approach can vary greatly depending on the size, location, and timing of gastrointestinal wall defect recognition. Some asymptomatic patients can be treated conservatively, while patients with septic symptoms or cardio-pulmonary insufficiency may require intensive care and urgent surgical treatment. However, most gastrointestinal wall defects can be satisfactorily treated by endoscopy. Although the initial endoscopic closure rates of chronic fistulas is very high, the long-term results of these treatments remain a clinical problem. The efficacy of endoscopic therapy depends on several factors and the best mode of treatment will depend on a precise localization of the site, the extent of the leak and the endoscopic appearance of the lesion. Many endoscopic tools for effective closure of gastrointestinal wall defects are currently available. In this review, we summarized the basic principles of the management of acute iatrogenic perforations, as well as of postoperative leaks and chronic fistulas of the gastrointestinal tract. We also described the effectiveness of various endoscopic methods based on current research and our experience.

Keywords: Endoscopic; Management; Perforation; Leak; Fistula; Stent; Clips

Core tip: Most gastrointestinal perforations, leaks and fistulas can be satisfactorily treated by endoscopy. The efficacy of endoscopic therapy depends on several factors. Many endoscopic tools for effective closure of gastrointestinal wall defects are currently available. In this review, we summarize the basic principles of the management of acute iatrogenic perforations, as well as of postoperative leaks and chronic fistulas of gastrointestinal tract. We also described the effectiveness of various endoscopic methods based on current research and our experience.