Endoscopic clip application as an adjunct to closure of mature esophageal perforation with fistulae

Background & Aims: Esophageal perforation is associated with high morbidity and mortality. Surgery and drainage are considered primary management. Conservative management is an option in a select group. Conservative treatment requires drainage, control of infection, nutritional support, and considerable patience. Methods: We describe 3 cases in which endoscopic metallic clips were placed to close mature perforations with associated fistulae. All 3 patients underwent mucosal approximation of the defects under direct endoscopic visualization. Results: A review of the literature revealed only 4 other reports of the use of endoclipping for esophageal perforation, one diagnosed immediately, a second within 24 hours, a third diagnosed after 2 days and endoclipped after prolonged mediastinal drainage, and a fourth believed to be chronic. The cases presented here represent well-established, mature defects. Conclusions: Endoscopic treatment of mature esophageal perforation with metallic clips can be performed to promote closure. In combination with other conservative medical efforts, this method can be used safely and effectively for selected patients.