Transmural defects of the gastrointestinal tract can be classified into 3 distinct entities—leak, perforation, and fistula. Each arises from different mechanisms and is managed accordingly. Leaks occur most often after surgery, while perforations occur most often after flexible endoscopic maneuvers. Fistulae arise from a variety of mechanisms, such as an evolution from surgical leaks, as well as from specific disease states. Endoscopic management plays a vital role in the treatment of transmural defects as long as the region of interest can be accessed with the appropriate endoscopic accessories. Endoscopic approaches can be broadly classified into those that provide closure and those that provide diversion of luminal contents. With advances in technology, a myriad of devices and accessories are available that allow a tailored approach. Endoscopic approaches to leaks, perforations, and fistulae are discussed in this review.

胃肠道的透壁缺损可分为3个不同的实体-渗漏，穿孔和瘘管。每种机制都来自不同的机制，并据此进行管理。渗漏最常在手术后发生，而穿孔最常在柔性内窥镜检查后发生。瘘管是由多种机制引起的，例如由于外科手术的泄漏以及特定的疾病状态所引起的演变。内窥镜管理在经壁缺损的治疗中起着至关重要的作用，只要可以通过适当的内窥镜附件进入感兴趣的区域即可。内窥镜检查方法可大致分为提供封闭作用的方法和提供管腔内容物转移的方法。随着技术的进步，提供了无数的设备和附件，可以采用量身定制的方法。