Endoscopic management for gastrointestinal leaks, perforations, and fistulae - Technical tips and outcomes

Sep 28, 2026

Uploaded by Cart

Gastrointestinal (GI) tract defects are organized into three entities: leak, perforation, and fistula, each driven by different mechanisms and requiring tailored management. Leaks commonly follow surgery, perforations often result from flexible endoscopic maneuvers, and fistula formation reflects a range of causes and disease states. Endoscopic therapy aims to stop luminal content flow across the defect, guided by closure approach, defect size and location, and surrounding tissue viability, with multidisciplinary care and evolving device-based strategies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Abstract

Core Tip

Citation and Publication Details

| W | J | G | E | World Journal of
Gastrointestinal Endoscopy | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Endosc 2025 December 16; 17(12): 111782 DOI: 10.4253/wjge.v17.i12.111782 ISSN 1948-5190 (online) REVIEW Endoscopic management for gastrointestinal leaks, perforations, and fistulae: Technical tips and outcomes Chhagan L Birda, Jahnvi Dhar, Naveen Kumar, Shubhra Mishra, Giuseppe Dell'Anna, Cherring Tandup, Satish S Nagaraj, Stefano F Crinò, Vikramjit Mitra, Zaheer Nabi, Jayanta Samanta Specialty type: Gastroenterology and hepatology Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B, Grade C Novelty: Grade A, Grade C Creativity or Innovation: Grade B, Grade C Scientific Significance: Grade B, Grade C P-Reviewer: Okamoto K, MD, PhD, Associate Professor, Japan; Zhang Q, MD, Chief Physician, Vice Director, China Received: July 9, 2025 Revised: August 18, 2025 Accepted: November 4, 2025 Published online: December 16, 2025 Processing time: 160 Days and 9.4 Hours Chhagan L Birda, Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur 342005, India Jahnvi Dhar, Department of Gastroenterology and Hepatology, Punjab Institute of Liver and Biliary Sciences, Mohali 160062, Punjab, India Naveen Kumar, Department of Gastroenterology, Sri Harihar Hospital and Research Centre, Mandi 175021, Himachal Pradesh, India Shubhra Mishra, Department of Gastroenterology, The Gastro Liver Hospital, Kanpur 208002, Uttar Pradesh, India Giuseppe Dell'Anna, Department of Gastroenterology and Digestive Endoscopy, IRCCSOspedale San Raffaele, Milan 20132, Italy Cherring Tandup, Satish S Nagaraj, Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, Chandīgarh, India Stefano F Crinò, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37129, Italy Vikramjit Mitra, Department of Gastroenterology, University Hospital of North Tees, Stocktonon-Tees TS198PE, United Kingdom Zaheer Nabi, Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangana, India Jayanta Samanta, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandīgarh, India Corresponding author: Jayanta Samanta, DM, Additional Professor, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh Sector- 12, Chandigarh 160012, Chandīgarh, [India.](India. dj_samanta@yahoo.co.in)[ dj_samanta@yahoo.co.in](India. dj_samanta@yahoo.co.in) Abstract Gastrointestinal (GI) tract defects can be classified into three distinct entities: Leak, perforation, and fistula. Each arises from different mechanisms and is managed accordingly. Leaks occur most often after surgery, while perforations arise due to flexible endoscopic maneuvers. Fistulae arise from a variety of mechanisms, WJGE [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 16, 2025 Volume 17 Issue 12 Birda CL et al. Endoscopic management of leaks, perforation, fistulae including specific disease states. Endoscopic management is vital in treating such defects if the region of interest can be accessed with the appropriate endoscopic accessories. The primary goal of endoscopic therapy is to interrupt the flow of luminal contents across a GI defect. Considering the proper endoscopic approach to luminal closure, several basic principles must be considered. Outcomes are dependent on the size and exact location of the leak/fistula, as well as the viability of the surrounding tissue. Almost all complex leaks and fistulae must be approached in a multidisciplinary manner, collaborating with colleagues in nutrition,

FAQs

How are gastrointestinal defects classified in the review?

They are classified into three distinct entities: leak, perforation, and fistula. Each category arises from different mechanisms and is managed accordingly.

What is the main goal of endoscopic therapy for these defects?

The primary goal is to interrupt the flow of luminal contents across a GI defect using appropriate endoscopic closure approaches.

What factors influence outcomes after endoscopic management?

Outcomes depend on the size and exact location of the leak or fistula and the viability of the surrounding tissue. Multidisciplinary collaboration is emphasized for complex cases.

Sep 28, 2026

Uploaded by Cart