Novel endoscopic modalities for closure of perforations, leaks, and fistula in the gastrointestinal tract

Full-thickness gastrointestinal (GI) defects remain a daunting clinical problem in modern medicine. They vary in size, location in the GI tract, etiology, and chronicity. While traditionally managed with surgical techniques or medical management, technological advancements have created a third management option (therapeutic endoscopy), which often result in definitive defect closure. With the advent of these endoscopic therapies, many centers have moved to endoscopic management as first-line therapy of such defects. Optimal endoscopic management may require multimodal, multisession therapy, which occurs in the setting of a multispecialty management team. This manuscript reviews the use of endoscopic clips (both through-the-scope and over-the-scope), endolumenal stents, endoscopic suturing, endolumenal vacuum devices, and other emerging technologies in the managing of full-thickness GI defects. We examine the optimal clinical application of each modality and review their limitations.