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Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2025; 17(10): 107840
Published online Oct 16, 2025. doi: 10.4253/wjge.v17.i10.107840
Advancements in endoscopic closure: Embracing a new era of managing complications and postprocedural defects after endoscopic submucosal dissection
Michał Spychalski, Zofia Orzeszko, Przemysław Kasprzyk
Michał Spychalski, Department of General and Oncological Surgery, Medical University of Lodz, Lodz 90647, Lodzkie, Poland
Michał Spychalski, Przemysław Kasprzyk, Center of Bowel Treatment, Brzeziny Specialist Hospital, Brzeziny 95060, Lodzkie, Poland
Zofia Orzeszko, Department of Surgery, Jagiellonian University in Cracow, Krakow 31061, Malopolskie, Poland
Author contributions: Spychalski M conceptualized and supervised the review; Orzeszko Z and Kasprzyk P conducted a literature search, wrote the initial manuscript, and prepared the tables; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zofia Orzeszko, MD, Department of Surgery, Jagiellonian University in Cracow, Trynitarska 11, Krakow 31061, Malopolskie, Poland. zofia.orzeszko@uj.edu.pl
Received: April 1, 2025
Revised: May 25, 2025
Accepted: September 2, 2025
Published online: October 16, 2025
Processing time: 201 Days and 8.3 Hours
Abstract

Endoscopic submucosal dissection (ESD) has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal (GI) tract. Advances in endoscopic closure techniques have developed alongside improvements in resection methods. Recent innovations, such as endoscopic hand suturing and new through-the-scope clips and systems, are transforming the field. Along with new devices, the combined methods of closure are developed. Embracing these new techniques can lead to enhanced recovery and reduced complications, marking an important milestone in medical practice. In fact, the European Society of GI Endoscopy recommends against routine closure of the ESD defect, except in duodenal ESD; however, endoscopic closure is strongly advised for immediate perforations. Furthermore, the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques. On the other hand, the most common postprocedural complications following ESD are delayed bleeding, delayed perforation, and stricture formation. According to recent literature, properly managing the post-ESD defect may reduce the risk of these complications. This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.

Keywords: Endoscopy; Endoscopic closure techniques; Endoscopic submucosal dissection; Through-the-scope clips; Over-the-scope-clips; Endoscopic hand suturing; OverStitch system; Mantis clip; X-Tack endoscopic HeliX tacking system

Core Tip: Certain resection sites after advanced endoscopic procedures should be considered for endoscopic closure. The choice of closure technique depends on defect size, location, tension, anatomy, cost, and clinician’s proficiency with the device. Traditional techniques like through-the-scope clips and over-the-scope clips are reliable for small to medium defects. Innovative solutions such as the X-TackTM HeliX system, OverstitchTM system, and MANTISTM Clip address larger or high-tension defects. endoscopic hand suturing and OverstitchTM system mimic surgical suturing, offering precise and durable closures for large or irregular defects, though it requires significant operator expertise and time. Combined techniques extend the possibilities for sufficient endoscopic closure.