Gastrointestinal perforations, leaks and fistulas may complicate endoscopic and surgical procedures. Surgical repair is associated with significant morbidity. Therapeutic endoscopic tools and techniques have included the application of tissue sealants, clip closure, and stent placement. Endoscopic suturing is a rapidly evolving minimally invasive technique. The OverStitchTM (Apollo Endosurgery, USA) is currently the only available endoscopic suturing system. Although technically more difficult than clip closure, endoscopic suturing allows closure of larger defects. In some settings, outcomes similar to surgical management with less morbidity may be achieved. This review describes the OverStitchTM endoscopic suturing system and the published literature regarding its use for perforations, leaks and fistulas.
Fistula* ; Intestinal Perforation* ; Stents

Background/Aims: Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB. Methods: Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included. Results: Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005). Conclusions EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.