Table 3. Summary.
| Types | Advantages | Concerns | |
|---|---|---|---|
| Endoscopic clipping | |||
| 1) TTSC | - Easier to use | - Maybe less effective for long-standing defects | |
| - Adaptable to various scenarios | - Complications: deviation during the procedure, obstruction, fistula injury, micro-perforation, additional damage to perforated sites, etc. | ||
| 2) OTSC | - Full-thickness closure, up to 2cm in size | ||
| - Low procedure related complications | |||
| Stent | |||
| 1) SEPS | - Promotes mucosal healing by closing the defect and redirecting its contents | - Primary concern include the risk of stent migration and patient intolerance | |
| 2) SEMS (FCSEMS and PCSEMS) | - Encourage early oral intake | - Endoscopic suture anchoring may be performed | |
| - Reduce risk of stricture formation | - Other complications: tissue hyperplasia, stricture formation, perforation, fistula development, chest pain, mucosal erosion, food impaction, bleeding, etc. | ||
| - High reported success rate | |||
| Endoscopic internal drainage | - Reduced risk of reoperation or gastro-cutaneous fistula formation | - Often requires longer duration to achieve treatment | |
| - Promising results with high success rate | - Severe adverse event has been reported: double stent migration into peri-gastric cavity, and more critically, splenic artery or spleen | ||
| - Enables early enteral feeding | |||
| - Effective management of sepsis through drainage | |||
| - Improve patient mobility, shorten hospital stays, reduced risk of complications (e.g., DVT and HAP) | |||
| - Most of adverse events are amendable to conservative treatment | |||
| Endoscopic suturing | |||
| OverStitch | - Potential precision | - Requires additional training and expertise | |
| - Can offer effective treatment option by achieving full-thickness closure of the defect | |||
| Endoscopic vacuum assisted system | - Rapid closure of the defect due to faster ingrowth of granulation tissue | - Complications: bleeding and few cases of anastomotic site stricture after its removal | |
| - High success rate | - Two severe adverse events that have been reported: tracheoesophageal fistula and esophageal ulcer due to suction catheter | ||
| - Benefit of draining necrotic debris and pus; thus, prevent spread of inflammation and promote tissue healing | |||
| - Does not have much procedure related complication | |||
| Tissue sealant | |||
| 1) Fibrin glue | - High success rate | - Repeated sessions | |
| 2) Cyanoacrylate | - Reduced treatment duration | - Large volumes of sealants necessary | |
| - Gap in their application in post-gastric surgery anastomosis leaks | |||
TTSC = through-the-scope clipping; OTSC = over-the-scope clipping; SEPS = self-expandable plastic stent; SEMS = self-expandable metal stent; FCSEMS = fully covered self-expandable metal stent; PCSEMS = partially covered self-expandable metal stent; DVT = deep vein thrombosis; HAP = hospital acquired pneumonia.