Endoscopic management of esophageal perforations and tears

Esophageal perforation is a life-threatening condition burdened by high morbidity and mortality. The esophageal perforation can occur spontaneously (such as Boerhaave syndrome) or can be an iatrogenic complication. The diagnostic approach may be difficult as the clinical presentations is often non-specific. However, a proper and early diagnosis is crucial to reduce the mortality rate. Once the diagnosis is obtained, the therapeutic management differs among the different clinical scenarios. In some cases, a wait and watch approach is preferred, in other cases a more aggressive treatment is required. Although surgery was considered the standard of care, nowadays endoscopy is emerging as the first line treatment in esophageal perforations non-responsive to medical treatments. The endoscopic techniques available are the application of through-the-scope clips (TTSCs), over-the-scope clips, esophageal stents, endoscopic suturing techniques, endoluminal vacuum therapy (EVT), and locoregional application of regenerative medicine. The choice of the specific endoscopic technique depends on the injury length, the perforation site, and the presence of fluid collections. The complexity of the diagnostic and therapeutic approach to esophageal perforation imposes a multidisciplinary approach in order to choose the proper treatment in each singular case. The aim of this study is to assess the role of endoscopy in the management of esophageal injuries and to describe the endoscopic techniques nowadays available.