Endoscopic treatment of gastrointestinal perforations and leaks: Why, when, and how?

Gastrointestinal leaks and perforations are severe conditions that require urgent management. While these conditions were traditionally treated surgically, a growing body of evidence suggests that endoscopic treatment may be more suitable in a significant proportion of cases. Furthermore, the evolution of therapeutic endoscopy has led to an increased number of such cases being diagnosed during the initial intervention, providing the opportunity for prompt endoscopic treatment. The decision between endoscopic and surgical therapy, as well as the specific type of endoscopic therapy to use, depends on the type and site of perforation, the timing, and the individual characteristics of each patient. It is essential that clinicians can accurately identify patients who are suitable for endoscopic treatment and those who require surgical intervention. Furthermore, there are many areas where high-quality data on the comparison of different modalities are lacking. This manuscript aims to illustrate the patients for whom endoscopic treatment may be indicated and the modalities that can be used for defect closure and prevention of complications.