Techniques for endoscopic suturing

Surgeons and gastroenterologists have long desired tools to perform minimally invasive extraluminal endoscopic interventions. A critical instrument for such procedures would be a closure device to manage iatrogenic defects, prompting the development of ever-evolving endoscopic suturing devices. The current iteration of a commercially available suturing system provides several critical technological leaps forward, including full thickness bites, the flexibility to deploy running or interrupted sutures, and the capability of reloading sutures without the removal of the device from the patient. Recognized applications of endoscopic suturing within the foregut and hindgut include tissue apposition to manage perforation, defect closure, fistula, anastomotic leaks, and bleeding as well as stent fixation, as well as bariatric interventions such as post Roux-en-Y gastric bypass outlet reduction and endoscopic sleeve gastroplasty. While these topics are discussed in detail elsewhere, the present chapter is intended to discuss proper, optimized basic endoscopic suturing technique, suture patterns, as well as the necessary equipment and assembly.