How to deal with lower gastrointestinal defects: the role of endoscopy

Lower gastrointestinal (GI) defects, including leaks, perforations, and fistulas, pose significant challenges for diagnosis and management. These conditions are associated with high morbidity and mortality rates, necessitating effective treatment strategies to restore GI continuity and improve patient outcomes.

This special report examines current evidence and future perspectives on the endoscopic management of lower GI defects. A literature search was conducted in PubMed, Google Scholar, and Scopus for studies published up to July 2025 that focused on the endoscopic management of lower GI defects. It provides an overview of various endoscopic techniques, including clips, endosuturing, stents, endoscopic internal drainage, endoscopic vacuum therapy, and emerging regenerative approaches, and their underlying advantages and limitations. The need for more standardized and larger studies to establish guidelines has been addressed.

Endoscopy is increasingly being recognized as a therapeutic option for lower GI defects, offering less invasive alternatives to traditional surgery. The challenges in developing standardized protocols are due to diverse clinical scenarios and limited prospective data. Future advancements are expected in technologies and personalization of treatments. A multidisciplinary approach is essential to achieve optimal outcomes in this complex field.