Closure of transmural defects in the gastrointestinal tract by methods other than clips and sutures

Traditionally, the mainstay of therapy for transmural defects of the gastrointestinal tract has been surgical repair. However, in recent years, the spectrum of novel and innovative therapies available for the repair of such defects has been rapidly increasing, and patients now have a variety of nonsurgical options available to them for specific indications. In this article, we review the devices and techniques, other than clips and sutures, which have been developed for the closure of transmural defects. In this review, we include some well-known and commonly available interventions, such as tissue adhesives and endoscopic band ligation, as well as novel combinations of common techniques, such as the “clutching rose stems” technique and endoloop and endoclip closure. Additionally, we include a review of various innovative devices that have been explored, such as the AMPLATZER Septal Occluder, endoluminal vacuum therapy, and the T-tag tissue apposition system. Such devices and techniques represent a dynamic area of development currently, with many showing promising early results in treatment of transmural gastrointestinal defects. With further refinement, these devices and techniques may enter mainstream therapeutic use in the future.