Another Tool in the Endoscopic Closure Toolbox

Another Tool in the Endoscopic Closure Toolbox

Rajesh N. Keswani, MD, MS, reviewing Keihanian T, et al. Gastrointest Endosc 2023 Apr 13.

Endoscopic closure techniques are essential for successful closure of resection sites and acute perforations. Initially largely limited to through-the-scope (TTS) clips, the armamentarium has evolved to include over-the-scope (OTS) clips, OTS suturing, and TTS suturing. Each of these has its own advantages and disadvantages, making selection of which modality to utilize an individualized decision per case. 

OTS suturing previously required a double-channel endoscope, limiting its use due to the bulkiness of the assembled apparatus and decreased availability of double-channel endoscopes. Thus, TTS suturing and, more recently, a single-channel endoscope-compatible OTS suturing modality have been released.

In this report, the authors describe their initial outcomes of the newly released OTS single-channel endoscopic suturing system. They prospectively collected the outcomes of suturing after ESD procedures. Most lesions were in the rectum (64%), followed by the stomach (15.2%). Of note, only two duodenal lesions and no lesions on the right side of the colon were included in this series. 

Among the 33 patients enrolled in the study, 31 underwent successful closure with the single-channel OTS suturing device. Of the two failures, one was due to cinch malfunction. However, the other technical failure appeared to be specifically related to the device itself, occurring when the device became misaligned with the endoscope during scope manipulation. There were no reports of adverse events that could be directly related to the device.



This is an early report on the needed adaptation of existing technology. It is encouraging to see the successful outcomes using this OTS suturing device that is compatible with a single-channel endoscope. However, whether this will facilitate closure in more challenging locations – namely, the right side of the colon and duodenum – remains unclear. More fundamentally, whether OTS suturing is superior to TTS closure techniques (either suturing or clipping) requires study. As with most new technologies, we still have more questions than answers.


Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Keihanian T, Zabad N, Khalaf M, et al. A novel suturing device enables safe and effective closure of large defects after endoscopic submucosal dissection. Gastrointest Endosc 2023 Apr 13. (Epub ahead of print) (

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