Endoscopic Management of Complications: Perforations, Fistulas, and Bleeding

Managing Perforations After EMR

• 💡 Perforation following Endoscopic Mucosal Resection (EMR) in the duodenum was managed using the OverStitch device for endoscopic suturing.
• 🎯 The process involved taking full-thickness bites with the OverStitch device to ensure complete closure of the defect.
• 📌 In the proximal stomach, a pinpoint perforation after EMR was successfully closed using an over-the-scope clip (OTSC) due to the defect's size.

Gastric Fistula Closure

• 🚀 A persistent gastriccutaneous fistula following PEG placement was addressed using an over-the-scope clip.
• 🔬 Argon plasma coagulation was employed around the fistula track to promote mucosal apposition before clip placement.

Management of Bleeding Post-Resection

• ⚠️ The video covers the management of bleeding that occurs after the endoscopic resection of a polyp near the gastroesophageal junction.
• ⚡ A hot snare was used to resect a raised lesion, and subsequent bleeding was addressed.

Endoscopic Tools and Techniques

• 🛠️ This series highlights the application of various endoscopic tools, including endoscopic suturing, over-the-scope clips, and argon plasma coagulation.
• ✅ Becoming proficient with these endoscopic interventions can enable surgeons to manage complex patients nonoperatively.