Endoscopic Closure Techniques for Perforations, Leaks, and Fistulae: Review Article

Full-thickness gastrointestinal tract defects (FGTDs) have been an unsettling occurrence in clinical practice, with an increasing incidence due to the growing use of third-space endoscopy and surgical procedures. With advancing technology, many of these events are now being managed endoscopically in a minimally invasive manner, and surgery is being increasingly reserved for refractory cases. Available devices for their treatment include through-the-scope clips, over-the-scope clips, endoscopic suturing devices, self-expandable metal stents, and endoscopic vacuum therapy.

In this review, we present available literature on different techniques for endoscopic defect closure and discuss their indications, efficacy, and limitations.

There is a scarcity of guidelines regarding FGTD endoscopic treatment. Selection of devices is still largely dependent on endoscopist's preference, while considering defect size, chronicity, characteristics of adjacent mucosa, and device availability.