Closing the Gap: Indications and Applications of Through-the-Scope Suturing

The widespread adoption of advanced endoscopic techniques has transformed the management of gastrointestinal disorders. En bloc resection during endoscopic submucosal dissection and tunneling techniques like peroral endoscopic myotomy often result in mucosal defects that require closure to minimize the risk of adverse events. Endoscopists have a range of closure tools available, including endoscopic clips and over-the-scope suturing systems. However, over-the-scope devices present challenges such as a steep learning curve, limited maneuverability in difficult locations, and the need for scope withdrawal for application of the device. The introduction of the through-the-scope suturing system in 2020 has significantly advanced endoscopic interventions.