Comparing the safety and efficacy of over-the-scope suturing, through-the-scope suturing, and endoscopic hand suturing for closure of GI defects after endoscopic resection: systematic review and meta-analysis.

Background And Aims: Data comparing the efficacy and safety of OverStitch (Apollo Endosurgery, Marlborough, Mass, USA), X-Tack (Apollo Endosurgery), and endoscopic hand suturing (EHS) for closure of GI defects after endoscopic resection are limited. We conducted a meta-analysis of the available data.

Methods: Online databases were searched for studies evaluating different closure systems for GI defects. The outcomes of interest were technical success, clinical success, and adverse events. Pooled proportions were calculated.

Results: Fifteen studies (4 for EHS, 6 for OverStitch, 4 for X-Tack, and 1 for both OverStitch and X-Tack) were included. The pooled outcomes for EHS were 98% technical success, 96% clinical success, 2% adverse events, 3% bleeding, and 1% perforation; for OverStitch were 93% technical success, 93% clinical success, 6% adverse events, 3% bleeding, and 3% perforation; and for X-Tack were 95% technical success, 94% clinical success, 3% adverse events, 2% bleeding, and 1% perforation.

Conclusions: All 3 closure methods showed comparable high technical and clinical success rates. EHS and X-Tack had lower adverse event rates than OverStitch. Future direct comparison studies are needed to corroborate our findings.