Endoscopic suturing for closure of transmural defects

For many years reliable endoscopic closure of transmural defects of the gastrointestinal (GI) tract has remained a challenging task. These defects can be caused by unintentional complications of diagnostic and therapeutic endoscopy (perforation) or they can be a result of full-thickness resection of GI tract lesions. Perforation during flexible endoscopy still remains the most worrisome complication, which usually requires urgent surgical (or laparoscopic) intervention for closure of the perforation or resection of affected segment of GI tract. Over the last 20 years various instruments and accessories have been used for closure of transmural GI tract defects. Although closure of the accidental small defects could be achieved with through-the-scope hemostatic clips, these devices are not suitable for tissue opposition of defects with large diastasis between the tissue edges. To eliminate shortcomings of clips closure, various types of endoscopic suturing device (suction based, working overtubes with preloaded stitches, T-bars, over-the-scope clips, etc.) have been tried for closure of transmural defects. However, these devices have numerous inherent problems and many are no longer commercially available. The most recent version of Overstitch endoscopic suturing device in the United States is versatile, user-friendly and allows reliable, full-thickness, “surgical quality” airtight closure of transmural GI tract defects. Overstitch endoscopic suturing device is an important tool for closure of transmural GI tract defects and should be considered in endoscopy centers performing high-risk, advanced diagnostic and therapeutic endoscopic procedures.