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.