Endoscopic Full-Thickness Defects and Closure Techniques

Abstract

Purpose of review: Gastrointestinal transmural defects are defined as total rupture of the gastrointestinal wall and can be divided into three main categories: perforations, leaks and fistulas. Due to an increase in the number of therapeutic endoscopic procedures including full thickness resections and the increase incidence of complications related to bariatric surgeries there has been an increase the number of transmural defects seen in clinical practice and the number of non-invasive endoscopic treatment procedures used to treat these defects. Recent findings: The variety of endoscopic approaches and devices, including closure techniques using clips, endoloop and endoscopic sutures; covering techniques such as the cardiac septal occluder device, luminal stents and tissue sealants; and drainage techniques including endoscopic vacuum therapy, pigtail and septotomy with balloon dilation are transforming endoscopy as the first-line approach for therapy of these conditions. Summary: In this review, we describe the various transmural defects and the endoscopic techniques and devices used in their closure.

Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review

“…The most common causes include chronic inflammation, malignancy, and untreated longterm leaks. [1][2][3] Endoscopic closure of a GI fistula represents a major advancement in the treatment of patients. An appropriate endoscopic approach to fistula closure includes several basic principles.…”

“…The established epithelial tract near unhealthy tissues makes GI fistulas one of the most challenging complications to treat endoscopically. [1][2][3] The variety of endoscopic approaches and devices, including closure, covering, and drainage methods, is transforming endoscopy as the first-line approach for the treatment of these conditions. Closure and covering endoscopic therapies include the use of clips, cap mounted clips, self-expandable metal stents (SEMSs), tissue sealants, and endoscopic sutures.…”

Endoscopic management of duodenal fistula in a patient operated after abdominal injury

“…In 1993, the first work was published on endoscopic closure of gastrointestinal perforation with a haemostatic clip (gastric perforation) [7]. In the last 2-3 years, many scientific papers were published on the management of the upper and lower gastrointestinal fistula using advanced endoscopic methods [5,8,9].…”

“…The fistula opening in the descending part of the duodenum was closed with an Over-the-Scope clip (OTSC type gc 12 mm, Ovesco Endoscopy AG). After applica- fistulas [5,8,9,10,11]. Among all the aforementioned injuries, fistulas are the most difficult to close.…”

“…Endoscopic techniques aimed at closing full-thickness gastrointestinal defects include: TTS (through-the-scope), covered selfexpanding metal stents (CSEMS), endoscopic stitching techniques (e.g. OverStitch™, Apollo Endosurgery), endoscopic internal drainage, endoscopic vacuum therapy (EVT), tissue adhesives and OTS (over-the-scope) clips [5,8,9,10].…”