Clin Endosc.  2016 Sep;49(5):438-443. 10.5946/ce.2016.104.

Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations

• Takeshita
• Ho KY

• KMID: 2356049
• DOI: http://doi.org/10.5946/ce.2016.104

Abstract

Full-thickness gastrointestinal defects such as perforation, anastomotic leak, and fistula are severe conditions caused by various types of pathologies. They are more likely to require intensive care and a long hospital stay and have high rates of morbidity and mortality. After intentional full-thickness opening of hollow organs for natural orifice transluminal endoscopic surgery, safe and secure closure is urgently required. The currently available advanced endoscopic closing techniques have a major role in the treatment of full-thickness gastrointestinal defects. Appropriate usage of these techniques requires taking into account their advantages and limitations during practical application. We reviewed the available endoscopic modalities, including endoscopic clips, stents, vacuum-assisted closure, gap filling, and suturing devices, discussed their advantages and limitations when treating full-thickness gastrointestinal defects, and explored emerging innovations, including a novel endoluminal surgical platform for versatile suturing and a cell-laden scaffold for effective gap filling. Although these emerging technologies still require further pre-clinical and clinical trials to assess their feasibility and efficacy, the available modalities may be replaced and refined by these new techniques in the near future.

Keyword

Endoscopic closure; Perforation; Anastomotic leak; Fistula; Full-thickness gastrointestinal defect

MeSH Terms

Anastomotic Leak
Critical Care
Fistula
Length of Stay
Mortality
Natural Orifice Endoscopic Surgery
Negative-Pressure Wound Therapy
Pathology
Stents

Figure

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  Fig. 1. Master and slave transluminal endoscopic robot suturing with adjustability and versatility in a dry setting.

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  Fig. 2. Collaboration between master and slave transluminal endoscopic robot and endoscopic clips in an animal experiment. The grasper holds the defect and provides a suitable situation for clip application.

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  Fig. 3. Esophageal fibroblasts cultured on a polycaprolactone scaffold fabricated using a three-dimensional printing technique. (A) Polycaprolactone scaffold (B) before fibroblast seeding and (C, D) after fibroblast culture (day 14).

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