Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 10, 2015; 7(8): 758-768
Published online Jul 10, 2015. doi: 10.4253/wjge.v7.i8.758
Comprehensive management of full-thickness luminal defects: The next frontier of gastrointestinal endoscopy
Joshua S Winder, Eric M Pauli
Joshua S Winder, Eric M Pauli, Penn State Milton S. Hershey Medical Center, Hershey, PA 17036, United States
Author contributions: Winder JS and Pauli EM wrote the editorial in its entirety and contributed equally to its composition.
Conflict-of-interest statement: Winder JS has no financial affiliations to disclose; Pauli EM has received honoraria from Cook Biotech for speaking and consulting.
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: Eric M Pauli, MD, Assistant Professor, Penn State Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA 17033, United States. epauli@hmc.psu.edu
Telephone: +1-717-5317462 Fax: +1-717-5314729
Received: January 29, 2015
Peer-review started: January 29, 2015
First decision: March 6, 2015
Revised: March 26, 2015
Accepted: May 5, 2015
Article in press: May 8, 2015
Published online: July 10, 2015
Abstract

Full thickness gastrointestinal defects such as perforations, leaks, and fistulae are a relatively common result of many of the endoscopic and surgical procedures performed in modern health care. As the number of these procedures increases, so too will the number of resultant defects. Historically, these were all treated by open surgical means with the associated morbidity and mortality. With the recent advent of advanced endoscopic techniques, these defects can be treated definitively while avoiding an open surgical procedure. Here we explore the various techniques and tools that are currently available for the treatment of gastrointestinal defects including through the scope clips, endoscopic suturing devices, over the scope clips, sealants, endoluminal stents, endoscopic suction devices, and fistula plugs. As fistulae represent the most recalcitrant of defects, we focus this editorial on a multimodal approach of treatment. This includes optimization of nutrition, treatment of infection, ablation of tracts, removal of foreign bodies, and treatment of distal obstructions. We believe that by addressing all of these factors at the time of attempted closure, the patient is optimized and has the best chance at long-term closure. However, even with all of these factors addressed, failure does occur and in those cases, endoscopic therapies may still play a role in that they allow the patient to avoid a definitive surgical therapy for a time while nutrition is optimized, and infections are addressed.

Keywords: Perforation, Fistula, Anastomotic leak, Over the scope clips, Overstitch, Stent, Endoscopic

Core tip: Endoscopic methods are replacing surgical options as the first line therapy for a wide array of gastrointestinal tract defects. Here we will review the available endoscopic modalities, their appropriate applications and their respective success rates. The fusion of standard surgical principles with flexible, intra-luminal modalities is likely to be the key to the successful endoscopic management of these challenging clinical problems.