Copyright ©The Author(s) 2020.
World J Gastroenterol. Aug 7, 2020; 26(29): 4198-4217
Published online Aug 7, 2020. doi: 10.3748/wjg.v26.i29.4198
Table 1 Definition of leak and fistula
LeakPathological communication between intra and extra-luminal compartments
FistulaAbnormal communication between two epithelialized surfaces
Table 2 Main features of the different endoscopic approaches to leak and fistula
Mechanism ofactionAdvantagesDisadvantagesCostN° of sessionsExpertise needed
EndoclipsDirect closureMore effective in acute settingLess effective in chronic setting; Need of external drainage+++
StentDefect sealingEarly oral intake; Reduce stricture formationStent migration; Tissue ingrowth/overgrowth pain; Need of externaldrainage+++++
EIDSecond intention closureEarly oral intake; Internal drainage; More effective in acute settingStricture+++++
Suturing systemDirect closureTrue full-thickness closure; Single operator (Overstich®)On healthy tissue; More difficult in tight endoluminal space and tangential suturing site+++++++
EVTSecond intention closureContinuous drainage; More effective in early stageLimited to rectal/esophageal site; Need of de-functioning stoma; Less effective if late diagnosis+++++
Tissue sealantMiscellaneousAntibacterial (cyanoacrylate); Used in combination; No inflammatory reaction (Surgisis®)On dry areas (fibrin glue); Inflammatory reaction (cyanoacrylate/fibrin glue)++++