Endoscopic management of fistulas, perforations, and leaks

Baruah, Anushka; Song, Louis M. Wong Kee; Buttar, Navtej

doi:10.1016/j.tgie.2016.02.001

Cited by 6 publications

(17 citation statements)

References 134 publications

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“…More recently, endoscopic closure has also been reported with high success rates, including the use of stents, sealants and clipping. Endoscopic Vacuum Therapy (EVT) is a more novel approach that has been proposed, but has yet to gain widespread acceptance [11,12]. Robotic flexible endoscopy represents another growing field that may be used to repair bowel perforation in the future [13].…”

Section: Managementmentioning

confidence: 99%

“…However, the Eagle Claw's initial design led to the development of the Overstitch, likely the most common endoscopic suturing device [16,24]. Disadvantages of the Overstitch include limited device mobility in addition to proficiency requirements with a convoluted activation process [11,18]. Placement of endoscopic sutures by this method may not result in seal-proof closure, but is often successful in approximating opposing tissue margins to reduce the size of the perforation.…”

Section: Endoscopic Therapiesmentioning

confidence: 99%

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Repair of Bowel Perforation: Endoscopic State of the Art

Wheeler¹

2023

JRMBR

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Background: Intestinal damage from various etiologies can result in the potentially dangerous complication of bowel perforation. Emergent treatment of small bowel perforation includes surgical repair with or without small bowel resection. As the number of therapeutic and diagnostic endoscopic procedures increase, more studies may be required to properly evaluate and report incidences of bowel perforation. Given the advantages of interventional procedures, novel endoscopic technologies which may prove beneficial in bowel perforation repair are continuously undergoing development. Bowel perforation can lead to peritonitis and sepsis – a medical emergency requiring immediate attention. Following diagnosis, hemodynamically stable patients may be treated conservatively whereas unstable patients undergo more intensive surgical procedures. Endoscopic procedures for bowel perforation repair also exist and recent advances in technology are furthering the scope of such closure methods. Methods and Findings: Endoscopic suturing technologies, while capable, require extensive training and entail prolonged activation processes. Wound vacuum sponge closure via endoscopy provides convergence of wound defects but may not be efficacious in defects larger than 5 cm. Furthermore, this method may be limited by inadequate seal and placement in the intestine. Endoscopic clipping is another modality beneficial for smaller perforations only. T-tag suturing has shown promising results in ex-vivo studies but entails blind placement of T-tags for perforation closure. Stents can be inserted endoscopically under fluoroscopic visual guidance. This technique, however, may result in stent migration, perforations and potential occlusions. Sealants can be injected for perforation closure but have not demonstrated clear efficacy. Robotic flexible endoscopy provides several novel features yet may require advanced training and sometimes more than one operator. As interventional procedures continue to gain popularity, a better understanding of endoscopic modalities is helpful for furthering their development. Regarding bowel perforation, this review aids in an overall understanding of the technologies which exist and are advancing further into more standard modalities for practical medical applications. Conclusion: There are currently various methods to repair perforation of the gastrointestinal wall and except for urgent exploratory laparotomy when indicated, there is likely no single method that is superior to others. It may be beneficial for the physician to consider all options for repair when evaluating a potential bowel perforation, considering physician preference and individual success or difficulty with a given modality. In more recent years as the focus has narrowed on minimally invasive procedures, future modalities will likely include increased automation and ease of use with the help of robotics, which will hopefully lead to decreased time to diagnosis, faster recovery and reduced morbidity and mortality.

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Section: Managementmentioning

confidence: 99%

Section: Endoscopic Therapiesmentioning

confidence: 99%

Repair of Bowel Perforation: Endoscopic State of the Art

Wheeler¹

2023

JRMBR

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“…40 Colorectal complications related to post-surgical fistulas occur in 3%-11% of cases (6% being considered the overall rate). [41][42][43] The surgical, endoscopic and radiological management has clearly redesigned and improved the management of these fistulas. Fistula care is provided by a team including surgeons, nurses, enterostomal therapists, social workers and nutritionists who will personalize a treatment plan.…”

Section: Introductionmentioning

confidence: 99%

Local administration of stem cell-derived extracellular vesicles in a thermoresponsive hydrogel promotes a pro-healing effect in a rat model of colo-cutaneous post-surgical fistula

et al. 2021

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“…Postsurgical leaks and fistulas are devastating adverse events (AEs) leading to prolonged hospitalization, considerable morbidity, and significant mortality. 1 An anastomotic leak is the strongest independent risk factor for postoperative mortality, with rates up to 15%. Spontaneous closure rates of leaks with conservative and radiologic interventions are highly variable, ranging from 16% to 46%.…”

mentioning

confidence: 99%

“…Spontaneous closure rates of leaks with conservative and radiologic interventions are highly variable, ranging from 16% to 46%. 1 In patients who undergo rescue or redo surgery, the mortality increases to 15% to 30% and recurrence in up to one third of patients. 1 In this issue of Gastrointestinal Endoscopy, Rodrigues-Pinto et al 2 present the results from a retrospective multicenter international study on endoscopic treatment of upper GI postsurgical leaks.…”

mentioning

confidence: 99%

Endoscopic management of fistulas, perforations, and leaks

Cited by 6 publications

References 134 publications

Repair of Bowel Perforation: Endoscopic State of the Art

Repair of Bowel Perforation: Endoscopic State of the Art

Local administration of stem cell-derived extracellular vesicles in a thermoresponsive hydrogel promotes a pro-healing effect in a rat model of colo-cutaneous post-surgical fistula

Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dike

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