Current applications of endoscopic suturing

Figure 3 Closure of colonic perforation with endoscopic suturing device. A: Initial tissue bites forming a running suture (B-E) starting at the inferior edge of the perforation and progressing towards the center; F: Tissue helix retractor is used to ensure deep tissue bite along the distal, superior edge of the perforation; G: Suturing has reached the superior edge of the perforation the edges of which are now being pulled together by the sutures; H: After tightening of the sutures closure of the perforation has been achieved and the cinch device is seen being deployed at the 6 o’ clock position of the image; I: Immediately after cinch deployment, the complete closure of the perforation is seen. Gastrograffin was injected through the scope that confirmed absence of leak (not shown).