{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:47:26Z","timestamp":1779893246304,"version":"3.53.1"},"reference-count":50,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Colon Rectal Surg"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Endoscopic closure is an essential technique to perform safe advanced endoscopy. Without appropriate closure of a defect, patients can experience spillage of fecal contents into the peritoneal cavity resulting in abdominal sepsis. The essential components to performing endoscopic closure are assessing the defect appropriately and choosing the correct closure technique. Assessing the defect involves five separate elements: timing, size, depth, shape, blood flow, and location in the colon or rectum. Understanding how each of these elements contributes toward a successful closure allows an endoscopist to choose the proper technique for closure. There have been many types of closure techniques described in the literature but the most common are through the scope clips, over the scope clips, and endoscopic suturing. There are advantages and disadvantages of each of these closure techniques. In this manuscript, we will discuss these common techniques as well as some additional techniques and the situations where they can be employed.<\/jats:p>","DOI":"10.1055\/s-0043-1770944","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T22:47:55Z","timestamp":1689806875000},"page":"302-308","source":"Crossref","is-referenced-by-count":4,"title":["Assessment and Techniques for Endoscopic Closure"],"prefix":"10.1055","volume":"37","author":[{"given":"Ragavan","family":"Siddharthan","sequence":"additional","affiliation":[{"name":"Capitol District Colon and Rectal Surgery Associated, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Marcello","sequence":"additional","affiliation":[{"name":"Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1007\/s11938-018-0199-6","article-title":"Endoscopic full-thickness defects and closure techniques","volume":"16","author":"D TH de Moura","year":"2018","journal-title":"Curr Treat Options Gastroenterol"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.giec.2017.11.010","article-title":"Endoscopic closure of gastrointestinal fistulae and leaks","volume":"28","author":"J Cho","year":"2018","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"77","DOI":"10.21037\/ales.2019.05.07","article-title":"Current techniques for combined endoscopic and laparoscopic surgery (CELS)","volume":"4","author":"E R Noren","year":"2019","journal-title":"Ann Laparosc Endosc Surg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"728704","DOI":"10.3389\/fmed.2021.728704","article-title":"Endoscopic management of complex colorectal polyps: current insights and future trends","volume":"8","author":"R Mann","year":"2022","journal-title":"Front Med (Lausanne)"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1053\/j.gastro.2019.03.019","article-title":"Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial","volume":"157","author":"H Pohl","year":"2019","journal-title":"Gastroenterology"},{"issue":"10","key":"ref6","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1097\/MCG.0000000000000409","article-title":"Endoscopic treatment of gastrointestinal perforations, leaks, and fistulae","volume":"49","author":"T Rustagi","year":"2015","journal-title":"J Clin Gastroenterol"},{"key":"ref7","volume-title":"Intestinal Perforation, in StatPearls","author":"J Hafner","year":"2022"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.gie.2008.09.008","article-title":"Risk of perforation from a colonoscopy in adults: a large population-based study","volume":"69","author":"G Arora","year":"2009","journal-title":"Gastrointest Endosc"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/gutjnl-2014-308481","article-title":"Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis","volume":"65","author":"C Hassan","year":"2016","journal-title":"Gut"},{"issue":"S 01","key":"ref10","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/j.1443-1661.2012.01252.x","article-title":"Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors","volume":"24","author":"S Tanaka","year":"2012","journal-title":"Dig Endosc"},{"issue":"09","key":"ref11","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1007\/s11605-010-1249-0","article-title":"Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity","volume":"14","author":"A Csendes","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"39936","DOI":"10.1038\/srep39936","article-title":"Very early colorectal anastomotic leakage within 5 post-operative days: a more severe subtype needs relaparatomy","volume":"7","author":"Y W Li","year":"2017","journal-title":"Sci Rep"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1055\/s-0036-1580630","article-title":"Management of colorectal anastomotic leak","volume":"29","author":"M S Thomas","year":"2016","journal-title":"Clin Colon Rectal Surg"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.critrevonc.2016.06.008","article-title":"Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: a systematic review","volume":"104","author":"A De Ceglie","year":"2016","journal-title":"Crit Rev Oncol Hematol"},{"issue":"08","key":"ref15","doi-asserted-by":"crossref","first-page":"368","DOI":"10.4253\/wjge.v8.i8.368","article-title":"Delayed perforation after endoscopic submucosal dissection for early gastric cancer: clinical features and treatment","volume":"8","author":"T Yano","year":"2016","journal-title":"World J Gastrointest Endosc"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0016-5107(97)70003-8","article-title":"Is in vivo measurement of size of polyps during colonoscopy accurate?","volume":"46","author":"N Gopalswamy","year":"1997","journal-title":"Gastrointest Endosc"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.4172\/2161-069X.1000329","article-title":"Polyp size estimation strategies during endoscopy procedures: a review","author":"F Mart\u00ednez","year":"2015","journal-title":"J Gastrointest Dig Syst"},{"key":"ref18","volume-title":"Physiology, Large Intestine, in StatPearls","author":"L L Azzouz","year":"2022"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"362","DOI":"10.5946\/ce.2012.45.4.362","article-title":"Principles of quality controlled endoscopic submucosal dissection with appropriate dissection level and high quality resected specimen","volume":"45","author":"T Toyonaga","year":"2012","journal-title":"Clin Endosc"},{"issue":"10","key":"ref20","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1136\/gutjnl-2015-309848","article-title":"Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors","volume":"66","author":"N G Burgess","year":"2017","journal-title":"Gut"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/j.gie.2011.08.007","article-title":"Endoscopic management of colonoscopic perforations (with videos)","volume":"74","author":"G S Raju","year":"2011","journal-title":"Gastrointest Endosc"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.gie.2011.08.050","article-title":"Endoscopic full-thickness GI wall resection: current status","volume":"75","author":"Y Kopelman","year":"2012","journal-title":"Gastrointest Endosc"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.tgie.2019.04.004","article-title":"Novel endoscopic modalities for closure of perforations, leaks, and fistula in the gastrointestinal tract","volume":"21","author":"J S Winder","year":"2019","journal-title":"Tech Gastrointest Endosc"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1053\/j.gastro.2019.08.036","article-title":"Prophylactic clip closure clarified: the question is not whether to clip, but when","volume":"157","author":"D K Rex","year":"2019","journal-title":"Gastroenterology"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1136\/gutjnl-2015-310249","article-title":"Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions","volume":"66","author":"M Pellise","year":"2017","journal-title":"Gut"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1002\/jmri.26909","article-title":"MRI safety and devices: an update and expert consensus","volume":"51","author":"P Jabehdar Maralani","year":"2020","journal-title":"J Magn Reson Imaging"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1080\/17434440.2019.1618707","article-title":"Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection","volume":"16","author":"A S Turan","year":"2019","journal-title":"Expert Rev Med Devices"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.gie.2015.08.074","article-title":"Endoscopic management of colonic perforations: clips versus suturing closure (with videos)","volume":"84","author":"S V Kantsevoy","year":"2016","journal-title":"Gastrointest Endosc"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1007\/s00464-007-9682-1","article-title":"Endoclipping of iatrogenic colonic perforation to avoid surgery","volume":"22","author":"R Magdeburg","year":"2008","journal-title":"Surg Endosc"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.tgie.2005.12.002","article-title":"Endoclips","volume":"8","author":"R W Yeh","year":"2006","journal-title":"Tech Gastrointest Endosc"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.gie.2021.10.018","article-title":"Initial multicenter experience using a novel endoscopic tack and suture system for challenging GI defect closure and stent fixation (with video)","volume":"95","author":"T Mahmoud","year":"2022","journal-title":"Gastrointest Endosc"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.gie.2016.07.037","article-title":"Clip retention rates and rates of residual polyp at the base of retained clips on colorectal EMR sites","volume":"85","author":"P L Ponugoti","year":"2017","journal-title":"Gastrointest Endosc"},{"issue":"04","key":"ref33","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.vgie.2019.12.010","article-title":"Double-channel double-grasper technique in over-the-scope clip deployment","volume":"5","author":"S J Tang","year":"2020","journal-title":"VideoGIE"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.gie.2015.03.1977","article-title":"Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature","volume":"82","author":"T Verlaan","year":"2015","journal-title":"Gastrointest Endosc"},{"issue":"07","key":"ref35","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.1007\/s00464-012-2754-x","article-title":"Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review","volume":"27","author":"T Weiland","year":"2013","journal-title":"Surg Endosc"},{"issue":"06","key":"ref36","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1177\/1553350613479204","article-title":"Safety and effectiveness of an endoscopic suturing device in a human colonic treat-and-resect model","volume":"20","author":"E M Pauli","year":"2013","journal-title":"Surg Innov"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.gie.2013.10.051","article-title":"Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos)","volume":"79","author":"S V Kantsevoy","year":"2014","journal-title":"Gastrointest Endosc"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"E623","DOI":"10.1055\/s-0034-1390782","article-title":"Full-thickness endoscopic suturing of staple-line leaks following laparoscopic sleeve gastrectomy","volume":"46","author":"J X Cai","year":"2014","journal-title":"Endoscopy"},{"issue":"06","key":"ref39","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1159\/000507224","article-title":"The Usefulness of an Endoscopic OverStitch Suturing System for Managing Anastomotic Dehiscence\u2013-a case report","volume":"27","author":"G Patil","year":"2020","journal-title":"GE Port J Gastroenterol"},{"issue":"11","key":"ref40","doi-asserted-by":"crossref","first-page":"3404","DOI":"10.1007\/s00464-015-4084-2","article-title":"Endoluminal full-thickness suture repair of gastrotomy: a survival study","volume":"29","author":"P Halvax","year":"2015","journal-title":"Surg Endosc"},{"issue":"07","key":"ref41","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/BF02238598","article-title":"Laparoscopic-assisted full-thickness endoscopic polypectomy","volume":"36","author":"D E Beck","year":"1993","journal-title":"Dis Colon Rectum"},{"issue":"07","key":"ref42","doi-asserted-by":"crossref","first-page":"3114","DOI":"10.1007\/s00464-018-6026-2","article-title":"Experience in colon sparing surgery in North America: advanced endoscopic approaches for complex colorectal lesions","volume":"32","author":"E Gorgun","year":"2018","journal-title":"Surg Endosc"},{"issue":"06","key":"ref43","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1055\/s-0030-1256345","article-title":"Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach","volume":"43","author":"G Loske","year":"2011","journal-title":"Endoscopy"},{"issue":"09","key":"ref44","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1097\/DCR.0000000000001762","article-title":"The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer","volume":"63","author":"Y N You","year":"2020","journal-title":"Dis Colon Rectum"},{"issue":"09","key":"ref45","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1308\/rcsann.2020.0135","article-title":"Should the rectal defect be sutured following TEMS\/TAMIS carried out for neoplastic rectal lesions? A meta-analysis","volume":"102","author":"K Khan","year":"2020","journal-title":"Ann R Coll Surg Engl"},{"issue":"03","key":"ref46","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1007\/s00464-016-5067-7","article-title":"The surgical defect after transanal endoscopic microsurgery: open versus closed management","volume":"31","author":"C Brown","year":"2017","journal-title":"Surg Endosc"},{"issue":"09","key":"ref47","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1111\/codi.14689","article-title":"A multi-centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery","volume":"21","author":"C J Brown","year":"2019","journal-title":"Colorectal Dis"},{"issue":"01","key":"ref48","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1053\/j.sult.2015.10.008","article-title":"Spectrum of Signs of Pneumoperitoneum","volume":"37","author":"A Pinto","year":"2016","journal-title":"Semin Ultrasound CT MR"},{"issue":"05","key":"ref49","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/00004728-199209000-00008","article-title":"Diagnosis of pneumoperitoneum: abdominal CT vs. upright chest film","volume":"16","author":"J C Stapakis","year":"1992","journal-title":"J Comput Assist Tomogr"},{"issue":"01","key":"ref50","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3348\/kjr.2009.10.1.63","article-title":"Gastrointestinal tract perforation: MDCT findings according to the perforation sites","volume":"10","author":"S H Kim","year":"2009","journal-title":"Korean J Radiol"}],"container-title":["Clinics in Colon and Rectal Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1770944.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T16:18:43Z","timestamp":1730823523000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1770944"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":50,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2024,8,8]]},"published-print":{"date-parts":[[2024,9]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1770944","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1531-0043","1530-9681"],"issn-type":[{"value":"1531-0043","type":"print"},{"value":"1530-9681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,19]]}}}