Esophageal Perforations: An Endoscopic Approach to Management

  • Shelly GurwaraEmail author
  • Steven Clayton
Esophagus (J Clarke and N Ahuja, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Esophagus


Purpose of Review

Esophageal perforations are associated with high morbidity and mortality. As opposed to surgical repair, endoscopic closure techniques have emerged over the years as a more minimally invasive approach for management. Our goal is to discuss different modalities for closure.

Recent Findings

Through-the-scope clips (TTSCs), over-the-scope clips (OTSCs), and esophageal stent placement are well known options for closure. We will also discuss the more recent technique of endoscopic suturing for closure of larger defects as well as prevention of esophageal stent migration. For mediastinal collections associated with perforations, a more novel endoluminal vacuum therapy (EVT) for drainage may be an option.


Overall, there are several different endoscopic options that can tailored to the specific features of an esophageal perforation. This review will discuss various techniques with which a gastroenterologist or thoracic surgeon should be familiar.


Esophagus Perforation Endoscopic management Over-the-scope clip Esophageal stent Endoscopic suturing 


Compliance with Ethical Standards

Conflict of Interest

Shelly Gurwara and Steven Clayton declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Vidarsdottir H, Blondal S, Alfredsson H, Geirsson A, Gudbjartsson T. Oesophageal perforations in Iceland: a whole population study on incidence, aetiology and surgical outcome. Thorac Cardiovasc Surg. 2010;58(8):476–80. Scholar
  2. 2.
    Chirica M, Champault A, Dray X, Sulpice L, Munoz-Bongrand N, Sarfati E, et al. Esophageal perforations. J Visc Surg. 2010;147(3):e117–28. Scholar
  3. 3.
    Gonzalez JM, Benezech A, Barthet M. Complications of submucosal endoscopy. Best Pract Res Clin Gastroenterol. 2016;30(5):783–91. Scholar
  4. 4.
    Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77(4):1475–83. Scholar
  5. 5.
    Feldman M, Friedman LS, Sleisenger MH. Sleisenger & Fordtrans gastrointestinal and liver disease: pathophysiology, diagnosis, management. 10th ed. Philadelphia: Saunders Elsevier; 2010.Google Scholar
  6. 6.
    Bladergroen MR, Lowe JE, Postlethwait RW. Diagnosis and recommended management of esophageal perforation and rupture. Ann Thorac Surg. 1986;42(3):235–9.CrossRefGoogle Scholar
  7. 7.
    Hayashi I, Yonezawa TM, Kuwabara TKI. The study on staunch clip for the treatment by endoscopy. Gastrointest Endosc. 1975;17:92–101.Google Scholar
  8. 8.
    Watkins JR, Farivar AS. Endoluminal therapies for esophageal perforations and leaks. Thorac Surg Clin. 2018;28(4):541–54. Scholar
  9. 9.
    Saxena P, Khashab MA. Endoscopic management of esophageal perforations: who, when, and how? Curr Treat Options Gastroenterol. 2017;15(1):35–45. Scholar
  10. 10.
    Stavropoulos SN, Modayil R, Friedel D. Closing perforations and postperforation management in endoscopy: esophagus and stomach. Gastrointest Endosc Clin N Am. 2015;25(1):29–45. Scholar
  11. 11.
    Haito-Chavez Y, Law JK, Kratt T, Arezzo A, Verra M, Morino M, et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc. 2014;80(4):610–22. Scholar
  12. 12.
    Hagel AF, Naegel A, Lindner AS, Kessler H, Matzel K, Dauth W, et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg. 2012;16(11):2132–8. Scholar
  13. 13.
    Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag HJ, Messmann H, et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut. 2018;67(7):1280–9. Scholar
  14. 14.
    Shin EJ, Ko CW, Magno P, Giday SA, Clarke JO, Buscaglia JM, et al. Comparative study of endoscopic clips: duration of attachment at the site of clip application. Gastrointest Endosc. 2007;66(4):757–61. Scholar
  15. 15.
    Voermans RP, Le Moine O, von Renteln D, Ponchon T, Giovannini M, Bruno M, et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol. 2012;10(6):603–8. Scholar
  16. 16.
    Dasari BV, Neely D, Kennedy A, Spence G, Rice P, Mackle E, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg. 2014;259(5):852–60. Scholar
  17. 17.
    DaVee T, Irani S, Leggett CL, Berzosa Corella M, Grooteman KV, Wong Kee Song LM, et al. Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents. Surg Endosc. 2016;30(6):2332–41. Scholar
  18. 18.
    Fischer A, Thomusch O, Benz S, von Dobschuetz E, Baier P, Hopt UT. Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg. 2006;81(2):467–72. Scholar
  19. 19.
    Sharma P. Kozarek R; Practice parameters committee of American College of Gastroenterology. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2010;105(2):258–73; quiz 274. Scholar
  20. 20.
    Wright A, Chang A, Bedi AO, Wamsteker EJ, Elta G, Kwon RS, et al. Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS). Surg Endosc. 2017;31(9):3489–94. Scholar
  21. 21.
    Ngamruengphong S, Sharaiha RZ, Sethi A, Siddiqui AA, DiMaio CJ, Gonzalez S, et al. Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study. Endoscopy. 2016;48(9):808. Scholar
  22. 22.
    Martins BC, Retes FA, Medrado BF, de Lima MS, Pennacchi CM, Kawaguti FS, et al. Endoscopic management and prevention of migrated esophageal stents. World J Gastrointest Endosc. 2014;6(2):49–54. Scholar
  23. 23.
    Freeman RK, Ascioti AJ, Giannini T, Mahidhara RJ. Analysis of unsuccessful esophageal stent placements for esophageal perforation, fistula, or anastomotic leak. Ann Thorac Surg. 2012;94(3):959–64; discussion 964-5. Scholar
  24. 24.
    Henderson JB, Sorser SA, Atia AN, Catalano MF. Repair of esophageal perforations using a novel endoscopic suturing system. Gastrointest Endosc. 2014;80(3):535–7. Scholar
  25. 25.
    •• Sharaiha RZ, Kumta NA, DeFilippis EM, Dimaio CJ, Gonzalez S, Gonda T, et al. A large multicenter experience with endoscopic suturing for management of gastrointestinal defects and stent anchorage in 122 patients: a retrospective review. J Clin Gastroenterol. 2016;50(5):388–92. This retrospective study showed high technical success rates for endoscopic suturing of luminal perforations.
  26. 26.
    Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc. 2008;22(8):1818–25. Scholar
  27. 27.
    •• Laukoetter MG, Mennigen R, Neumann PA, Dhayat S, Horst G, Palmes D, et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc. 2017;31(6):2687–96. Prospective study showing high healing rates of esophageal leakage with EVT.CrossRefGoogle Scholar
  28. 28.
    Bludau M, Hölscher AH, Herbold T, Leers JM, Gutschow C, Fuchs H, et al. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc. 2014;28(3):896–901. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Section on GastroenterologyWake Forest Baptist Health Medical CenterWinston-SalemUSA

Personalised recommendations