Review Article| Volume 33, ISSUE 1, P169-182, January 2023

Endoscopic Closure

Tools and Techniques
  • Thomas R. McCarty
    Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

    Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • Pichamol Jirapinyo
    Corresponding author. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115.
    Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

    Harvard Medical School, Boston, MA, USA
    Search for articles by this author


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Gastrointestinal Endoscopy Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Asge Technology C.
        • Conway J.D.
        • Adler D.G.
        • et al.
        Endoscopic hemostatic devices.
        Gastrointest Endosc. 2009; 69: 987-996
        • Hayashi I.
        • Yonezawa T.M.
        • Kuwabara T.
        • et al.
        The study on staunch clip for the treatment by endoscopy.
        Gastrointest Endosc. 1975; 17: 92-101
        • Abdulfattah Bukhari M.
        • Khashab M.A.
        Optimized training in the use of endoscopic closure devices.
        Gastrointest Endosc Clin N Am. 2020; 30: 197-208
        • Sedarat A.
        Clips for closure of full-thickness defects.
        Tech Gastrointest Endosc. 2015; 17: 129-135
        • Raju G.S.
        • Ahmed I.
        • Shibukawa G.
        • et al.
        Endoluminal clip closure of a circular full-thickness colon resection in a porcine model (with videos).
        Gastrointest Endosc. 2007; 65: 503-509
        • Baron T.H.
        • Song L.M.
        • Ross A.
        • et al.
        Use of an over-the-scope clipping device: multicenter retrospective results of the first US experience (with videos).
        Gastrointest Endosc. 2012; 76: 202-208
        • Wang T.J.
        • Aihara H.
        • Thompson A.C.
        • et al.
        Choosing the right through-the-scope clip: a rigorous comparison of rotatability, whip, open/close precision, and closure strength (with videos).
        Gastrointest Endosc. 2019; 89: 77-86 e1
        • Kirschniak A.
        • Kratt T.
        • Stuker D.
        • et al.
        A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences.
        Gastrointest Endosc. 2007; 66: 162-167
        • Matthes K.
        • Jung Y.
        • Kato M.
        • et al.
        Efficacy of full-thickness GI perforation closure with a novel over-the-scope clip application device: an animal study.
        Gastrointest Endosc. 2011; 74: 1369-1375
        • Rustagi T.
        • McCarty T.R.
        • Aslanian H.R.
        Endoscopic treatment of gastrointestinal perforations, leaks, and fistulae.
        J Clin Gastroenterol. 2015; 49: 804-809
        • Sandmann M.
        • Heike M.
        • Faehndrich M.
        Application of the OTSC system for the closure of fistulas, anastomosal leakages and perforations within the gastrointestinal tract.
        Z Gastroenterol. 2011; 49: 981-985
        • Disibeyaz S.
        • Koksal A.S.
        • Parlak E.
        • et al.
        Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature.
        Clin Res Hepatol Gastroenterol. 2012; 36: 614-621
        • McCarty T.R.
        • Ryou M.
        Endoscopic diagnosis and management of gastric subepithelial lesions.
        Curr Opin Gastroenterol. 2020; 36: 530-537
        • committee At
        • Parsi M.A.
        • Schulman A.R.
        • et al.
        Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos).
        VideoGIE. 2019; 4: 285-299
        • Dolezel R.
        • Ryska O.
        • Kollar M.
        • et al.
        A comparison of two endoscopic closures: over-the-scope clip (OTSC) versus KING closure (endoloop + clips) in a randomized long-term experimental study.
        Surg Endosc. 2016; 30: 4910-4916
        • von Renteln D.
        • Schmidt A.
        • Vassiliou M.C.
        • et al.
        Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study.
        Endoscopy. 2009; 41: 481-486
        • Haito-Chavez Y.
        • Law J.K.
        • Kratt T.
        • et al.
        International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video).
        Gastrointest Endosc. 2014; 80: 610-622
        • Dolan R.D.
        • Bazarbashi A.N.
        • McCarty T.R.
        • et al.
        Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis.
        Gastrointest Endosc. 2022; 95: 216-224 e18
        • Jensen D.M.
        • Kovacs T.
        • Ghassemi K.A.
        • et al.
        Randomized controlled trial of over-the-scope clip as initial treatment of severe nonvariceal upper gastrointestinal bleeding.
        Clin Gastroenterol Hepatol. 2021; 19: 2315-23123.e2
        • Schmidt A.
        • Riecken B.
        • Damm M.
        • et al.
        Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series.
        Endoscopy. 2014; 46: 762-766
        • Stavropoulos S.N.
        • Modayil R.
        • Friedel D.
        Current applications of endoscopic suturing.
        World J Gastrointest Endosc. 2015; 7: 777-789
        • Moran E.A.
        • Gostout C.J.
        • Bingener J.
        Preliminary performance of a flexible cap and catheter-based endoscopic suturing system.
        Gastrointest Endosc. 2009; 69: 1375-1383
        • Thompson C.C.
        • Ge P.S.
        The use of the overstitch to close perforations and fistulas.
        Gastrointest Endosc Clin N Am. 2020 January; 30: 147-161
        • Kantsevoy S.V.
        • Bitner M.
        • Mitrakov A.A.
        • et al.
        Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos).
        Gastrointest Endosc. 2014; 79: 503-507
        • Han S.
        • Wani S.
        • Kaltenbach T.
        • et al.
        Endoscopic suturing for closure of endoscopic submucosal dissection defects.
        VideoGIE. 2019; 4: 310-313
        • Maselli R.
        • Palma R.
        • Traina M.
        • et al.
        Endoscopic suturing for gastrointestinal applications: initial results from a prospective multicenter european registry.
        Gastrointest Endosc. 2022;
        • Hernandez A.
        • Marya N.B.
        • Sawas T.
        • et al.
        Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video).
        Endosc Int Open. 2021; 9: E572-E577
        • McCarty T.R.
        • Aihara H.
        Hybrid endoscopic submucosal dissection with novel helix tacking system for defect closure.
        VideoGIE. 2021; 6: 446-449
        • Mahmoud T.
        • Wong K.
        • Song L.M.
        • et al.
        Initial multicenter experience using a novel endoscopic tack and suture system for challenging GI defect closure and stent fixation (with video).
        Gastrointest Endosc. 2022; 95: 373-382
        • de Moura D.T.H.
        • Hirsch B.S.
        • Do Monte Junior E.S.
        • et al.
        Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages.
        VideoGIE. 2021; 6: 523-528
        • do Monte Junior E.S.
        • de Moura D.T.H.
        • Ribeiro I.B.
        • et al.
        Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: systematic review and meta-analysis.
        Dig Endosc. 2021; 33: 892-902
        • de Moura D.T.H.
        • de Moura B.
        • Manfredi M.A.
        • et al.
        Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects.
        World J Gastrointest Endosc. 2019; 11: 329-344
        • Yang J.
        • Lee D.
        • Agrawal D.
        Closure of transmural defects in the gastrointestinal tract by methods other than clips and sutures.
        Tech Gastrointest Endosc. 2015; 17: 141-150
        • Committee A.T.
        • Bhat Y.M.
        • Banerjee S.
        • et al.
        Tissue adhesives: cyanoacrylate glue and fibrin sealant.
        Gastrointest Endosc. 2013; 78: 209-215
        • de Moura D.T.H.
        • da Ponte-Neto A.M.
        • Hathorn K.E.
        • et al.
        Novel endoscopic management of a chronic gastro-gastric fistula using a cardiac septal defect occluder.
        Obes Surg. 2020; 30: 3253-3254
        • Rabenstein T.
        • Boosfeld C.
        • Henrich R.
        • et al.
        First use of ventricular septal defect occlusion device for endoscopic closure of an esophagorespiratory fistula using bronchoscopy and esophagoscopy.
        Chest. 2006; 130: 906-909
        • Repici A.
        • Presbitero P.
        • Carlino A.
        • et al.
        First human case of esophagus-tracheal fistula closure by using a cardiac septal occluder (with video).
        Gastrointest Endosc. 2010; 71: 867-869
        • Nakagawa Y.
        • Nagai T.
        • Soma W.
        • et al.
        Endoscopic closure of a large ERCP-related lateral duodenal perforation by using endoloops and endoclips.
        Gastrointest Endosc. 2010; 72: 216-217
        • Shi Q.
        • Chen T.
        • Zhong Y.S.
        • et al.
        Complete closure of large gastric defects after endoscopic full-thickness resection, using endoloop and metallic clip interrupted suture.
        Endoscopy. 2013; 45: 329-334
        • Agrawal D.
        • Chak A.
        • Champagne B.J.
        • et al.
        Endoscopic mucosal resection with full-thickness closure for difficult polyps: a prospective clinical trial.
        Gastrointest Endosc. 2010; 71: 1082-1088
        • Dior M.
        • Coriat R.
        • Tarabichi S.
        • et al.
        Does endoscopic mucosal resection for large colorectal polyps allow ambulatory management?.
        Surg Endosc. 2013; 27: 2775-2781
        • Liaquat H.
        • Rohn E.
        • Rex D.K.
        Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions.
        Gastrointest Endosc. 2013; 77: 401-407
        • Omori J.
        • Goto O.
        • Habu T.
        • et al.
        Prophylactic clip closure for mucosal defects is associated with reduced adverse events after colorectal endoscopic submucosal dissection: a propensity-score matching analysis.
        BMC Gastroenterol. 2022; 22: 139
        • Dokoshi T.
        • Fujiya M.
        • Tanaka K.
        • et al.
        A randomized study on the effectiveness of prophylactic clipping during endoscopic resection of colon polyps for the prevention of delayed bleeding.
        Biomed Res Int. 2015; 2015: 490272
        • Matsumoto M.
        • Kato M.
        • Oba K.
        • et al.
        Multicenter randomized controlled study to assess the effect of prophylactic clipping on post-polypectomy delayed bleeding.
        Dig Endosc. 2016; 28: 570-576
        • Shioji K.
        • Suzuki Y.
        • Kobayashi M.
        • et al.
        Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy.
        Gastrointest Endosc. 2003; 57: 691-694