LAUSR

ment 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. In the current issue of Endoscopy, Krishnan et al. report on the clinical usefulness of a new endoscopic suturing device, the through-the-scope tack and suture (TTSS) system, which enables mucosal apposition by applying small tacks to the surrounding mucosa and drawing the defect closed with a string [1]. This technique allows defect closure in desirable forms, such as a running pattern or purse-string suturing, without endoscope withdrawal. The authors applied TTSS to several situations, including post-EMR and post-ESD mucosal defect, fistula closure, and stent fixation. This case series of 53 patients demonstrated favorable results in technical success (96%) as well as clinical success (92%), although the technique appeared to be less reliable in fistula closure (57%). The device is easily deployed, technically accessible for endoscopists, and minimally invasive for patients, as well as saving time. Hence, further clinical introduction and indicator expansion are expected.