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

Endoscopic submucosal dissection (ESD) has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal (GI) tract. Advances in endoscopic closure techniques have developed alongside improvements in resection methods. Recent innovations, such as endoscopic hand suturing and new through-the-scope clips and systems, are transforming the field. Along with new devices, the combined methods of closure are developed. Embracing these new techniques can lead to enhanced recovery and reduced complications, marking an important milestone in medical practice. In fact, the European Society of GI Endoscopy recommends against routine closure of the ESD defect, except in duodenal ESD; however, endoscopic closure is strongly advised for immediate perforations. Furthermore, the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques. On the other hand, the most common postprocedural complications following ESD are delayed bleeding, delayed perforation, and stricture formation. According to recent literature, properly managing the post-ESD defect may reduce the risk of these complications. This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.