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Review
. 2022 Feb 27:15:26317745221076705.
doi: 10.1177/26317745221076705. eCollection 2022 Jan-Dec.

Current endoscopic closure techniques for the management of gastrointestinal perforations

Dominic Staudenmann  1 , Kevin Kyung Ho Choi  1 , Arthur John Kaffes  1 , Payal Saxena  2
Affiliations
Review

Current endoscopic closure techniques for the management of gastrointestinal perforations

Dominic Staudenmann et al. Ther Adv Gastrointest Endosc. .

Abstract

Acute gastrointestinal perforations occur either from spontaneous or iatrogenic causes. However, particular attention should be made in acute iatrogenic perforations as timely diagnosis and endoscopic closure prevent morbidity and mortality. With the increasing use of diagnostic endoscopy and advances in therapeutic endoscopy worldwide, the endoscopist must be able to recognize and manage perforations. Depending on the size and location of the defect, a variety of endoscopic clips, stents, and suturing devices are available. This review aims to prepare and guide the endoscopist to use the right tools and techniques for optimal patient outcomes.

Keywords: clip; perforation; stent.

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Conflict of interest statement

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Flowchart 1.
Flowchart 1.
Approach to perforations in relation to size, location, and degree of contamination. *External drain placement may be performed laparoscopically or under radiological guidance.
Figure 1.
Figure 1.
Through the scope clip approach. Gentle air suction and deflation to bring mucosal borders of the perforation into apposition and initiating clip closure distally.
Figure 2.
Figure 2.
Through the scope clips clipping technique: (a) defect in oesophagus, (b) suction and deflation, starting to clip distally, (c) getting second clip in position close to the first one, and (d) defect closed in a zipper fashion technique.
Figure 3.
Figure 3.
Metal stent for treatment of an oesophagus perforation: (a) metal stent after placement and (b) closure control with contrast.
Figure 4.
Figure 4.
Endoscopic suturing device (OverStitch®).
Flowchart 2.
Flowchart 2.
Suggested approach for endoscopic closure of gastrointestinal perforations.
See this image and copyright information in PMC

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