Endoscopic closure of Gastrointestinal defects: Devices and Techniques

Advancements in therapeutic endoscopy have expanded the management of gastrointestinal (GI) diseases. Procedures such as endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR) frequently result in iatrogenic GI defects requiring secure closure to prevent complications like bleeding and perforation. While through-the-scope clips (TTSCs) are effective for small defects, larger or full-thickness defects necessitate alternative closure techniques. This review discusses the endoscopic closure devices, including TTSCs, over-the-scope clips (OTSCs), and endoscopic suturing systems. A structured literature search was conducted using PubMed and Embase, focusing on device efficacy, retention rates, and safety outcomes. Novel closure devices and robotic-assisted techniques are also discussed. The choice of closure technique depends on defect size, location, and tissue characteristics. TTSCs are suitable for small mucosal defects, while OTSCs and suturing devices enable robust closure for full thickness defects. While endoscopic suturing offers high closure strength, technical expertise is required. In near future, robotic-assisted endoscopy may enhance precision and efficiency of resection as well as closure of post-resection defects. Further research should focus on refining closure techniques and optimizing device selection to improve clinical outcomes.