|
| Type | Device | Advantages | Disadvantages |
|
| Primary closure techniques | Over-the-scope clips | Useful for small leaks [68, 76] | Frequent need of combined techniques [75, 76] |
| Tissue sealants | Extensively available in most centers [62] | Less effective for larger and chronic leaks [68] |
| Ease of use [62] | |
| Endoscopic suture | Useful for small leaks [70] | Less effective for larger and chronic leaks [72] |
| Not widely available [72] |
| Requires experienced endoscopist [72] |
| Poor clinical success [72] |
| Cardiac septal occluded | Useful for leaks with associated fistulas [81] | Less effective for larger leaks [81] |
| Requires experienced endoscopist [82] |
| Self-expandable metal stent | Early enteral nutrition [27] | Frequent but transitory symptoms after stent placement (nausea, vomiting, and/or retrosternal discomfort) [34] |
| Widely available in most centers | Multiple endoscopic sessions (larger leaks) [60] |
| Allow simultaneous dilation if concomitant stricture is present [28, 29] | Stent migration risk despite fixation [37] |
| | No consensus about best stent type [41–43] |
| Secondary closure techniques | Endoscopic vacuum therapy | Combines drainage and sealing [18] | Transnasal tube in situ for at least 3–4 weeks [90] |
| No need for percutaneous drain [84] | Multiple endoscopic procedures every 3–4 days (sponge exchange) [90] |
| Possibility of closure of larger and chronic defects [85] | Late enteral nutrition (total parenteral nutrition or jejunostomy is needed) [91] |
| Endoscopic internal drainage | No need for percutaneous drain [100] | Long period till leak closure [100] |
| Early oral feeding [16] | Complementary techniques may be needed (necrosectomy/endoscopic ultrasound guided drainage for complex collections) [102–104] |
| Early hospital discharge [16] | |
| Endoscopic septostomy | No need for percutaneous drain [21] | Multiple endoscopic procedures may be required [21] |
| Option in chronic refractory leaks [105] | Risk for perforation and/or bleeding [108] |
|
