Gastrointestinal leaks and fistulae can be serious acute complications or chronic conditions caused by inflammation, malignancy, or surgery. In a Perspective article in the October issue of Clinical Gastroenterology and Hepatology, Field F. Willingham and Jonathan M. Buscaglia discuss advanced endoscopic methods for less invasive treatment of these luminal defects.
They explain that the main goal of endoscopic therapy is to interrupt the flow of luminal contents across a gastrointestinal defect. Gastrointestinal leaks and fistulae can be managed using stent placement, clip closure (through-the-scope clips or over-the-scope devices), endoscopic suturing, or injection of tissue sealants.
The article includes a video demonstrating closure of distal esophageal fistula using an over-the-scope device with tissue graspers after removal of fully covered self-expanding metal stents that failed to seal the leak (left).
Willingham and Buscaglia discuss the basic principals to consider in selecting the proper endoscopic approach to luminal closure, drainage of cavities and fluid collections, and how the size and location of the leak/fistula, as well as the viability of the surrounding tissue, affect treatment options. The authors remind readers that management of complex leaks and fistulae requires a a multidisciplinary team involving expertise in nutrition, radiology, and surgery.