How should we evaluate the efficacy of endoscopic closure appropriately? A black box between interventions and outcomes.

Abstract

Endoscopic closure has drawn attention owing to the development and clinical introduction of various endoscopic interventions in the gastrointestinal tract. A mucosal closure is expected to prevent postoperative adverse events, such as bleeding and delayed perforation, in endoscopic intraluminal resection, for example endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Endoscopic full-thickness resection always necessitates a robust and sustained defect closure. Furthermore, gastrointestinal fistula requires a closure method that is less invasive than surgical interventions. Intentionally created defects become wider, deeper, and harder to close with only conventional methods using endoscopic clips owing to therapeutic endoscopic expansion. Therefore, dedicated suturing devices/techniques need to be further developed.