Postsurgical leaks are a major complication with significant mobidity and mortality. Conventional conservative and surgical approaches are highly morbid with limited success. Over the last decade several endoscopic techniques have proved effective with a favorable safety profile. Nevertheless, most data still come from retrospective series, and many studies included heterogenous patient groups pooling complex surgical leaks with minor endoscopic perforations. This review focuses on the endoscopic management of the more difficult postsurgical leaks. Stents and over-the-scope clips are currently the key endoscopic techniques for leak closure, but emerging techniques such as vacuum sponge therapy and endoscopic internal drainage have proved to be at least as effective. The current trend is to use these different techniques interchangeably or simultaneously rather than assuming a single standardized approach.
Anastomotic Leak ; Drainage ; Esophageal Fistula ; Gastric Fistula ; Humans ; Mortality ; Porifera ; Retrospective Studies ; Self Expandable Metallic Stents ; Stents ; Vacuum

Gastrointestinal leaks and fistulae are grave conditions associated with substantial morbidity and mortality. Expandable stents have shown significant success in the management of leaks and fistulae, providing an efficacious minimally invasive approach in patients who are frequently poor surgical candidates. Most reports, however, are limited by their small size or the pooling of different stents, techniques and locations of leaks and fistulae. Despite the numerous alterations in stent design, migration remains the pivotal drawback of this technique. In this article, we review the current status of expandable stents in the management of gastrointestinal leaks and fistulae, available anti-migration techniques and evolving innovations in stent design.
Anastomotic Leak ; Esophageal Fistula ; Fistula* ; Gastric Fistula ; Humans ; Mortality ; Stents*