Advancements in endoscopic closure: Embracing a new era of managing complications and postprocedural defects after endoscopic submucosal dissection

Table 7 Specifications of endoscopic closure devices

Device	Specifications
TTS clip[78,94]	Intermediate strength
	Fast application but may be challenging in large defects
	Easy to deliver (beneficial in the right colon and in difficult locations)
	Good choice in defects smaller that 2-3 cm
	Alternative and combined methods are available
	Cost-effectiveness depends on the number of clips used but is usually well maintained
OTS clip[78,94,107,159]	Intermediate strength in 15 mm defects
	Low strength in 30 mm defects
	Medium prolonging of the procedure but its rather easy to apply after proper training
	The diameter of the tip of the scope is increased with additional device (16.5-21 mm) that has irregular edges - it may cause difficulty in an introduction of the scope through the larynx and strictures of all origins (including radiation)
	Poor visibility due to bleeding may make the application not possible
	May lead to stenosis
	Allows only one attempt to close the defect
	May inadvertently capture structures beyond the gastrointestinal wall as seen in the reports of unintended inclusion of organs and vessels adjacent to the target site
	The newly introduced OTSC cutting device (remOVE system; Ovesco) allows for the removal of a deployed OTSC. When cutting OTSC, the electric DC impulses are delivered by a special electric generator connected to the grasping device
	However, it is important to note that the OTSC cutting device has a 10- to 15-minute warm-up time before it can be used. Therefore, removing a misdeployed OTSC and deploying a second OTSC on the misfired location would entail a significant time lag
EHS[78]	Appropriate for defects larger than 2-3 cm
	Feasible in various locations and depths
	High strength and secure closure
	Takes more time and is difficult to perform (extensive training is appropriate)
Overstitch[94]	High strength and secure closure
	Takes more time and is difficult to perform (extensive training is appropriate)
	May inadvertently capture structures beyond the gastrointestinal wall as seen in the reports of unintended inclusion of organs and vessels adjacent to the target site
	Is significantly more expensive than other devices
X-tack Helix[94]	Most beneficial in superficial defects smaller than 3 cm, but can be applied in more advances ones
	Low strength
	Medium prolonging of the procedure
	Application may be challenging
	May be removed with fully rotatable rat tooth forceps
	Cost-effective in specific indications

TTS: Through-the-scope; OTS: Over-the-scope; OTSC: Over-the-scope clip; DC: Direct current; EHS: Endoscopic hand suturing.