Endotherapy of leaks and fistula

Figure 1 Through the scope clips.

Figure 2 Endo clips (Through the scope) used to close an esophageal defect due to Boerhaave’s syndrome.

Figure 3 Over the scope clips (ovesco) (A) clip, (B) clip mounted on the endoscope, (C) anchor, (D) twin grasper.

Figure 4 Dual gastric leak following Whipple’s Surgery treated by over the scope clips. A and B: Anterior and posterior defects (arrows); C: Endoscopic view showing leak on anterior gastric wall (arrows); D and E: The OTS clips placed on anterior and posterior defects respectively; F and G: Follow-up CT scan showing the clips (arrows) with demonstration of closure of leaks. OTS: Over the scope.

Figure 5 Stents for gastrointestinal leaks/fistula.

Figure 6 Leak after duodeno-jejunostomy managed by luminal stenting. A: Contrast introduced through the surgical drain site shows the leak (arrow); B: Stent being deployed; C: Fully deployed covered stent; D: Contrast through the surgical drain shows the closure of the leak.

Figure 7 Danis stent.

Figure 8 Modified stent design to prevent stent migration.

Figure 9 Anchoring of stent using (A) clip and (B) externalized thread.

Figure 10 Apollo overstitch device.

Figure 11 Endoscopic vacuum-assisted closure sponge (Endovac Therapy).