Protopapas AA, Kyritsi V, Tsavdaris D, Mekras A, Savopoulos C, Michalopoulos A, Paramythiotis D. Endoscopic treatment of gastrointestinal perforations and leaks: Why, when, and how? World J Gastrointest Endosc 2026; 18(1): 114033 [DOI: 10.4253/wjge.v18.i1.114033]
Corresponding Author of This Article
Daniel Paramythiotis, Full Professor, Department of First Propaedeutic Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, St. Kyriakidi 1, Thessaloniki 54636, Greece. danosprx@auth.gr
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Gastroenterology & Hepatology
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Review
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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/
Jan 16, 2026 (publication date) through Jan 15, 2026
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Protopapas AA, Kyritsi V, Tsavdaris D, Mekras A, Savopoulos C, Michalopoulos A, Paramythiotis D. Endoscopic treatment of gastrointestinal perforations and leaks: Why, when, and how? World J Gastrointest Endosc 2026; 18(1): 114033 [DOI: 10.4253/wjge.v18.i1.114033]
World J Gastrointest Endosc. Jan 16, 2026; 18(1): 114033 Published online Jan 16, 2026. doi: 10.4253/wjge.v18.i1.114033
Endoscopic treatment of gastrointestinal perforations and leaks: Why, when, and how?
Adonis A Protopapas, Vaia Kyritsi, Dimitrios Tsavdaris, Alexandros Mekras, Christos Savopoulos, Antonios Michalopoulos, Daniel Paramythiotis
Adonis A Protopapas, Vaia Kyritsi, Christos Savopoulos, Department of First Propaedeutic Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki 54636, Greece
Dimitrios Tsavdaris, Antonios Michalopoulos, Daniel Paramythiotis, Department of First Propaedeutic Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki 54636, Greece
Alexandros Mekras, Department of General and Visceral Surgery, Elisabeth Hospital, Wittlich 54516, Germany
Author contributions: Protopapas AA and Kyritsi V contributed to drafting; Protopapas AA, Kyritsi V, Tsavdaris D, and Mekras A contributed to final approval and critical revision for important intellectual content, and final approval; Protopapas AA, Kyritsi V, Savopoulos C, Michalopoulos A, and Paramythiotis D contributed to conception and design; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel Paramythiotis, Full Professor, Department of First Propaedeutic Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, St. Kyriakidi 1, Thessaloniki 54636, Greece. danosprx@auth.gr
Received: September 10, 2025 Revised: September 28, 2025 Accepted: December 3, 2025 Published online: January 16, 2026 Processing time: 127 Days and 15.4 Hours
Abstract
Gastrointestinal leaks and perforations are severe conditions that require urgent management. While these conditions were traditionally treated surgically, a growing body of evidence suggests that endoscopic treatment may be more suitable in a significant proportion of cases. Furthermore, the evolution of therapeutic endoscopy has led to an increased number of such cases being diagnosed during the initial intervention, providing the opportunity for prompt endoscopic treatment. The decision between endoscopic and surgical therapy, as well as the specific type of endoscopic therapy to use, depends on the type and site of perforation, the timing, and the individual characteristics of each patient. It is essential that clinicians can accurately identify patients who are suitable for endoscopic treatment and those who require surgical intervention. Furthermore, there are many areas where high-quality data on the comparison of different modalities are lacking. This manuscript aims to illustrate the patients for whom endoscopic treatment may be indicated and the modalities that can be used for defect closure and prevention of complications.
Core Tip: Endoscopic management of perforations and leaks is becoming more and more prevalent. Additionally, new endoscopic modalities are constantly added to the gastroenterologist’s therapeutic arsenal, further reinforcing the concept of endoscopic closure as the initial treatment of choice in many cases. Gastroenterologists should be aware of current closure techniques and be able to determine which patients should be treated endoscopically and by which modality.
