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Endoscopic Management of Benign Esophageal Ruptures and Leaks

  • Endoscopy (P Siersema, Section Editor)
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Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion statement

Esophageal leaks (EL) and ruptures (ER) are rare conditions associated with a high risk of mortality and morbidity. Historically, EL and ER have been surgically treated, but current treatment options also include conservative management and endoscopy. Over the last decades, interventional endoscopy has evolved as an effective and less invasive alternative to primary surgery in these cases. A variety of techniques are currently available to re-establish the continuity of the digestive tract, prevent or treat infection related to the leak/rupture, prevent further contamination, drain potential collections, and provide nutritional support. Endoscopic options include clips, both through the scope (TTS) and over the scope (OTS), stent placement, vacuum therapy, tissue adhesive, and endoscopic suturing techniques. Theoretically, all of these can be used alone or with a multimodality approach. Endoscopic therapy should be combined with medical therapy but also with percutaneous drainage of collections, where present. There is robust evidence suggesting that this change of therapeutic paradigm in the form of endoscopic therapy is associated with improved outcome, better quality of life, and shortened length of hospital stay. Moreover, recent European guidelines on endoscopic management of iatrogenic perforation have strengthened and to some degree regulated and redefined the role of endoscopy in the management of conditions where there is a breach in the continuity of the GI wall. Certainly, due to the complexity of these conditions and the variety of available treatment options, a multidisciplinary approach is strongly recommended, with close clinical monitoring (by endoscopists, surgeons, and intensive care physicians) and special attention to signs of sepsis, which can lead to the need for urgent surgical management. This review article will critically discuss the literature regarding endoscopic modalities for esophageal leak and perforation management and attempt to place them in perspective for the physician.

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Authors and Affiliations

  1. Endoscopy Unit, Humanitas Clinical and Research Center, Via Manzoni, 56, Rozzano, 20089, Milan, Italy

    Milena Di Leo MD, Roberta Maselli MD, PhD, Elisa Chiara Ferrara MD, Laura Poliani MD & Alessandro Repici MD

  2. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Milena Di Leo MD & Alessandro Repici MD

  3. Gastroenterology Division, Rashid Hospital, Dubai Health Authority, Dubai, UAE

    Sameer Al Awadhi MD

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  1. Milena Di Leo MD
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  2. Roberta Maselli MD, PhD
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  3. Elisa Chiara Ferrara MD
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All authors drafted the manuscript, contributed to the revision, and approved the final version.

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Milena Di Leo, Roberta Maselli, Elisa Chiara Ferrara, Laura Poliani, Sameer Al Awadhi, and Alessandro Repici declare that they have no conflict of interest.

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Di Leo, M., Maselli, R., Ferrara, E.C. et al. Endoscopic Management of Benign Esophageal Ruptures and Leaks. Curr Treat Options Gastro 15, 268–284 (2017). https://doi.org/10.1007/s11938-017-0138-y

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