Anna Putra ^1,2* Karolina Bednarz ¹ Magdalena Marchaj ³ Karolina Sieroń ^2,4,5 Sebastian Kwiatek ^2,4 Zbigniew Mazan ²

• ¹ Hospital of the Ministry of the Interior and Administration in Katowice, Katowice, Poland
• ² Mazan Surgery Clinic, Katowice, Poland
• ³ Other, Chorzów, Poland
• ⁴ Division of Internal Diseases Oncology, Gastroenterology, Angiology and Department of Cardiology Intensive Care. Hospital of the Ministry of the Interior and Administration in Katowice, Katowice, Poland
• ⁵ Department of Physical Medicine, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland

Abstract: Introduction: Advances in endoscopic techniques have revolutionized gastrointestinal therapy, offering reduced morbidity and mortality with minimal invasiveness. Endoscopic procedures are used to treat subepithelial tumors, intestinal perforation, acute upper gastrointestinal hemorrhage, and early gastrointestinal malignancies. A significant innovation in this field is the Overstitch system from Apollo Endosurgery, which has demonstrated extraordinary potential in a variety of gastrointestinal interventions. Aim of the Study: The aim of this review is to evaluate the clinical applications, safety and effectiveness of the Overstitch endoscopic suturing system with specification in the field of bariatric treatment of obesity, treatment of upper gastrointestinal leaks in gastrointestinal procedures, performance of endoscopic submucosal dissection (ESD) and, in recent times, innovative treatment of gastroesophageal reflux. . Description of the State of Knowledge: The Overstitch system, compatible with both two-channel (TM) and single-channel (Sx) endoscopes, enables full-thickness suturing of the gastrointestinal tract. It has been effectively used in procedures such as bariatric surgeries, gastric bypass revisions, treatment of gastrointestinal leaks and gastropulmonary fistula closures. Studies have shown a high success rate in bariatric procedures in closing defects, reducing postoperative complications, and being minimally invasive. In the treatment of obesity, the Overstitch system in endoscopic sleeve gastroplasty has demonstrated significant weight loss and improved patient outcomes. Conclusions: Endoscopic suturing techniques, particularly the Overstitch system, have transformed the management of gastrointestinal diseases. The system offers a versatile, minimally invasive solution for various conditions, ensuring high success rates, reduced recovery times, and fewer complications. Its use in the treatment of obesity further highlights its importance in modern bariatrics, providing a safer alternative to traditional surgical methods. Keywords: Endoscopic suturing, Overstitch system, gastrointestinal hemorrhage, gastrointestinal leaks, endoscopic submucosal dissection, obesity treatment, endoscopic sleeve gastroplasty, minimally invasive surgery,