Background and Aims: Closure of endoscopic resection defects can be achieved with through-the-scope clips, over-the-scope clips, or endoscopic suturing. However, these devices are often limited by their inability to close large, irregular, and difficult-to-reach defects. Thus, we aimed to assess the feasibility and safety of a novel through-the-scope, suture-based closure system developed to overcome these limitations.Methods: This was a retrospective multicenter study involving 8 centers in the United States. Primary outcomes were feasibility and safety of early use of the device. Secondary outcomes were assessment of need for additional closure devices, prolonged procedure time, and technical feasibility of performing the procedure with an alternative device(s).Results: Ninety-three patients (48.4% women) with mean age 63.6 AE 13.1 years were included. Technical success was achieved in 83 patients (89.2%), and supplemental closure was required in 24.7% of patients (n Z 23) with a

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Background and study aims: Gastric outlet obstruction (GOO) is traditionally managed by surgical gastroenterostomy (surgical-GE) and enteral stenting (ES). EUS-guided gastroenterostomy (EUS-GE) is now a third option. Large studies assessing their relative risks and benefits with adequate follow-up are lacking. We conducted a comparative analysis of patients who underwent EUS-GE, ES, or surgical-GE for GOO. Patients and methods: In this retrospective comparative cohort study, consecutive patients presenting with GOO who underwent EUS-GE, ES, or surgical-GE at two academic institutions were reviewed and independently cross-edited to ensure accurate reporting. The primary outcome was need for re-intervention. Secondary outcomes were technical and clinical success, length of hospital stay (LOS), and adverse events (AE). Results: A total of 436 patients (232 EUS-GE, 131 ES, 73 surgical-GE) were included. The median duration of follow-up of the entire cohort was 185.5 days (IQR 55.25-454.25 days). The rate of re-intervention of the EUS-GE group was lower than the ES and surgical-GE groups (0.9%, 12.2%, and 13.7%, P<0.0001). Technical success was achieved in 98.3%, 99.2%, and 100% (P=0.58), and clinical success was achieved in 98.3%, 91.6%, and 90.4% (P<0.0001) in the EUS-GE, ES, and surgical-GE groups, respectively. The EUS-GE group had a shorter LOS (2 days vs. 3 days vs. 5 days, P<0.0001) and a lower AE rate than the ES and surgical-GE groups (8.6% vs. 38.9% vs. 27.4%, P<0.0001). Conclusion: This large cohort study demonstrates the safety and palliation durability of EUS-GE as an alternative strategy for GOO palliation in select patients.