Endoscopic approaches in the treatment of fistulas and gastrointestinal dehiscences

Abstract

Background: Gastrointestinal fistulas are serious surgical complications that can occur in different clinical ways and are responsible for increasing the morbidity and mortality of surgical procedures. In more than 2/3 of the cases, they result from previous surgical manipulations (recently also associated with therapeutic endoscopic procedures), with an overall mortality of 15-25%. Despite this, they can be treated with the help of various minimally invasive, effective, endoscopic techniques with less morbidity and mortality when compared to conventional surgical techniques, which usually require prolonged hospital stays. Objective: To review the literature seeking to synthesize the evidence related to endoscopic approaches in the treatment of gastrointestinal dehiscence and fistulas. The search was used through a virtual library known as MEDLINE/PUBMED through the so-called MESH terms, including: endoscopic[title] AND gastrointestinal[title] AND fistulae[title] and endoscopic AND gastrointestinal AND fistulae. All works that did not adequately address the proposed topic were excluded. Conclusion: There are a variety of endoscopic techniques available that are minimally invasive and have low morbidity and mortality rates, an aspect frequently highlighted in the studies evaluated. The different types of work presented in the literature highlighted the use of metallic stents, endoclips, sutures and the use of fibrin adhesives. As for future studies, it seems to be essential, for the continuous improvement in the application of these techniques, to carry out randomized or prospective clinical studies to define what would be the most efficient approach, including the possibility of combined therapy.