Advances in endoscopic closure techniques for endoscopic full-thickness resection

Table 1 Advantages and disadvantages of suture methods for endoscopic full-thickness resection

Technique	Maximum defect size	Strengths	Weaknesses
Endoscopic clip closure technique
Simple metallic clips	2 cm	Low cost, ease of use	Limited for large/irregular defects
Modified simple metallic clips	9 cm	Adaptable to large defects	Risk of clip detachment
OTSC	3 cm	Full-thickness grasp	Technical difficulty, lumen obstruction, high cost
Endoloop closure technique
Grasp-and-loop closure	3.5 cm	Short operation time, no gap closure	Only for double-channel endoscope
Metallic clip-assisted endoloop suture	7 cm	Adaptable to large, irregular defects	Risk of clip detachment
Reinforced endoloop suture	5 cm	Robust closure	Long operation time
Closing devices
FTRD	3 cm	Short operation time, procedural simplicity	High complication rate, strict lesion criteria
OverStitch	> 5 cm	Robust closure, effective for irregular defects	High cost, steep learning curve
Endoscopic hand suturing, "Figure-8" suturing	> 3 cm	Robust closure	Long operation time, steep learning curve, limited EFTR data
X-Tack	> 3 cm	Effective for irregular defects	Limited EFTR data

OTSC: Over-the-scope clips; EFTR: Endoscopic full-thickness resection.