Endoscopic Treatment of Perforations and Fistulas
With the development of natural orifice transluminal endoscopic surgery (NOTES) and the advances in endoscopic devices, the repair of fistulas and perforations can be more readily performed endoscopically. In this chapter, we describe various devices used for these indications. These include over-the-scope clips, the OverStitch Endoscopic Suturing System, cardiac septal defect occluders, and others. All of these techniques have been shown to be effective in select cases in the current literature. Future device modifications to permit better range of motion and more intricate manipulations within small gastrointestinal luminal surfaces will continue to improve these interventions and patient outcomes.
KeywordsEndoscopic closure Endoscopic suturing Over-the-scope clip Fistula closure Perforation closure
Video 7.1 Animation of the endoscopic suturing device closing a tissue defect (By Apollo Endosurgery) (MP4 13367 kb)