Endoscopic suturing techniques were firstly introduced by Swain and Mills in 1986.¹

In 1998, the FDA approved the first flexible endoscopic suturing device, which was primarily used for the management of gastroesophageal reflux disease. Since then, the use of endoscopic sutures in endoscopic procedures has been on the rise. The surgical experience gained from the use of this modality in addition to the rapid new technical and technological advancements in its design has helped physicians expand its use in managing a vast array of gastrointestinal conditions.²,³

Over the past few years, endoscopic suturing utilization in the management of several gastrointestinal conditions has become more prevalent. Endoscopic suturing was particularly helpful in the repair of upper and lower gastrointestinal defects including fistulas, anastomotic leaks, and perforations. In gastrointestinal conditions requiring the placement of esophageal stents to alleviate symptoms, stent migration has been reported in as many as 46% of cases; the recent use of endoscopic suturing for fixation has provided reduced migration rates, as well as better clinical outcomes for patients.²,³,⁴,⁵ Endoscopic suturing has also been used to treat ulcer bleeds by oversewing the ulcer bed.⁶

Obesity has been one of the major public health concerns, affecting more than one-third of the adults in the United States. The use of endoscopic suturing for both weight regain following gastric bypass surgery and endoscopic sleeve gastroplasty as a primary procedure, a minimally invasive intervention to counter obesity, has provided effective and sustained results
in weight loss.⁷ Endoscopic gastric sleeve has been shown to be a safe and effective weigh loss method associated with low adverse event and hospitalization length when compared to laparoscopic sleeve.⁸ Using the OverStitch device, for bypass patients, the outlet size is reduced, and in the primary procedure, the stomach is constricted in an accordion-like fashion followed by the use of endoscopic suturing, thus mimicking the surgical technique.

Over the past 2 decades, many systems have been developed for endoscopic suturing within the GI tract as listed below. Given that a number of these are not currently utilized in clinical practice, this chapter focuses on the widely used Apollo Endosurgery’s Overstitch system.

None of the suction-based suturing system is currently used in clinical practice in humans.⁹,¹⁰

EsophyX device is rarely used for endoscopic correction of gastroesophageal reflux disease, while NDO plicator is not commercially available.¹¹

This device is no longer available for clinical use.¹²,¹³,¹⁴,¹⁵

None of these systems is commercially available.¹⁶,¹⁷,¹⁸,¹⁹

G-Prox system is mostly used in bariatric patients for revision of dilated gastrojejunal anastomosis as it requires a special delivery system.²⁰,²¹,²²,²³,²⁴,²⁵,²⁶,²⁷