Gastroenterology and Hepatology

Biography

Biography: Romualdas Maskelis

Abstract

Surgical treatment has been the mainstay for the management of GI leakage from perforations, fistulae, or anastomotic dehiscence. Moreover, in the era of minimal invasive surgery, the need for endoscopic management is increasing. The use of new endoscopic closure devices such as the endoscopic suturing system and over-the-scope clip allows endoscopicts to expand the indications of endoscopic treatment.  Gastrointestinal (GI) leakage, fistulae and perforations can be seriously and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. The systematic review of the literature form 1966 to 2013 for studies that have been published on endoscopic closure of perforations is found more than 700 studies but only included 24 cohort studies (21 retrospective , 3 prospective) in the analysis. In the past years, covered self-expanding metal stents were the mainstay of endoscopic therapy. However, two new techniques are now available that enlarge the possibilities of defect closure.  In the past decades, endoscopic clip application has repeatedly been used as a minimally invasive treatment option for small leakages and fistulas of the upper GI tract.  We applicate OTSC clips (OVESCO) more than for 30 patients during the last six year. Till now we don’t have randomized trials on OTSC application, and most authors provide retrospective case series with heterogeneous indications and applications. Most studies included less than 20 patients with gastrointestinal perforations. The OTSC obviously is a very effective treatment option of GI tract perforations, and in our opinion it is clearly superior to the placement of covered stents. Furthermore, in case of failure, the OTSC procedure does not impair further treatment, such as surgery. Further studies are needed to compare the novel techniques to other treatment modalities, and to define their exact place in treatment algorithms of upper GI perforations. Successful endoscopic closure of acute iatrogenic perfora­tions in the GI tract can reduce medical costs and hospital stays and prevent the need for surgical intervention for the patient.