Marking can improve defect closure in endoscopic suturing systems

The emergence of endoscopic suturing systems (ESS) provides a nonsurgical approach to rescuing perforations during endoscopic resection of gastric gastrointestinal tumors [1] [2] [3]. OverStitch Sx (Boston Scientific, Marlborough, Massachusetts, USA) can be applied to most single-channel endoscopes at the cost of hindering maneuverability. Furthermore, achieving complete full-thickness poses a challenge owing to the anatomic complexities and the obscured visibility of the muscle defect beneath the flap. Endoscopic techniques of ESS remain unfamiliar to most endoscopists. The marking technique is occasionally employed in endoscopic sleeve gastroplasty but has seldom been mentioned in the context of defect closure.