Physical barriers or mechanical closure – how to seal the deal for upper GI fistulas?

Once it was the exclusive realm of surgeons to close pathological perforations or the occasional injudicious endoscopic intervention, but closure of gastrointestinal (GI) mural defects is now commonplace for the endoscopist. A dizzying array of tools have become available to the interventional endoscopist to either close or occlude defects, including mechanical clipping devices, endoscopic suturing applications, endoluminal stents, and vacuum suction therapies [1].