Endoscopic Interventions for Insufficiencies and Fistulas

Despite continuously evolving surgical procedures, anastomotic insufficiencies in the gastrointestinal tract still lead to significant morbidity and mortality. The development of interventional endoscopy has made conservative-interventional management of these complications possible in many cases. This chapter discusses three important endoscopic therapy options. Stent therapy has been used for many years, especially in the upper GI tract, to seal leaks and insufficiencies. Endoscopic vacuum therapy achieves drainage of insufficiency cavities through continuous suction, thus promoting the reduction and healing of insufficiencies. It is now available in clinical routine for the upper and lower GI tract. Finally, Over-the-Scope Clips (OTSC) have significantly expanded the possibilities of clip closure of fistulas and leaks.