Cinching the Potential of the Overstitch System: The Role of Endoscopic Suturing in the Management of Perforations and Fistulas.

Gastrointestinal (GI) perforations and fistulas carry a significant morbidity and mortality risk for patients and pose unique management challenges for endoscopists. Although historically managed with surgical takedown and repair, advancements in endoscopic closure technologies have increasingly enabled effective minimally invasive treatment. Among these, endoscopic suturing has emerged as a versatile platform, capable of achieving full-thickness closure across a range of clinical scenarios. This article reviews the current evidence, procedural considerations, and clinical outcomes associated with endoscopic suturing for the treatment of GI perforations and fistulas, highlighting its growing role as a first-line therapeutic option in appropriately selected cases.