Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Figure 25 Large gastric defect after full thickness resection of neuroendocrine tumor closed with endoscopic suturing. A: Four-centimeter full thickness wound in posterior body of stomach, omental fat seen at base of defect; B: First suture - use helical tissue retractor to grab left edge of distal defect; C: After taking first bite on distal left (needle going from mucosa to serosa), second bite on distal right (needle going from serosa to mucosa); D: Approximately 8 bites are taken, alternating from left to right, with the last bite having the needle from mucosa-serosa-mucosa in single throw; E: First continuous running suture completed and needle anchor released for tightening and suture release; F: Second row of running suture placed for double reinforcement; G: Double suture closure completed; H: Contrast study shows luminal narrowing with no leak.