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BO Aadam_leak fistula defects

Pdf Summary

The document comprises a detailed presentation on the endoscopic closure of gastrointestinal leaks, fistulas, and mucosal defects, conducted by Dr. A. Aziz Aadam at Northwestern University Feinberg School of Medicine. Dr. Aadam's disclosures indicate involvement with several medical companies such as Boston Scientific and Medtronic.<br /><br />The presentation explores various endoscopic toolsets and techniques relevant to acute perforations, mucosal defect closure, and the management of leaks and fistulas. Key techniques include Through-the-Scope (TTS) clips, Over-the-Scope Clip (OTSC) systems, endoscopic suturing, stent placements, and endoscopic vacuum therapy. The document emphasizes the effectiveness of these techniques in managing acute perforations, often resulting from procedures like Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection (ESD).<br /><br />For leaks, which have a high mortality and morbidity rate, the document advocates for a conservative management approach complemented by endoscopic interventions like stent placement and internal drainage. A multicenter study cited reports a technical success rate of over 90% for endoscopic treatment of postsurgical leaks. However, recurrent leaks and the need for multimodal treatment approaches are also noted.<br /><br />In terms of fistula management, endoscopic techniques show varying levels of success. Suturing has been highlighted, especially in gastrogastric fistulas, to close fistulas initially but with a risk of recurrence.<br /><br />The presentation concludes that endoscopic management of acute perforations generally achieves high success rates but notes variability and challenges in treating leaks and fistulas. Thus, a multidisciplinary approach remains essential. The document ends with an invitation to contact Dr. Aadam for further inquiries or details.

Keywords

endoscopic closure

gastrointestinal leaks

fistulas

mucosal defects

Dr. A. Aziz Aadam

endoscopic techniques

stent placement

endoscopic suturing

multidisciplinary approach

Northwestern University