Inclusion Criteria:  > 18 years of age Undergoing closure of a gastrointestinal luminal defect for which a suturing device would be otherwise indicated  Exclusion Criteria:  INR > 2 Platelets < 150 Ongoing anticoagulation not meeting ASGE Antithrombotic Guidelines (Acosta RD et al, The Management of Antithrombotic Agents for Patients Undergoing GI Endoscopy, Gastrointest Endosc, 2016; 83(1): 3-16) Hemodynamic instability Ongoing or anticipated pregnancy