Purpose of Review <p>Acute gastrointestinal perforations were historically managed surgically. However, advances in endoscopic closure devices have shifted management toward minimally invasive approaches. This review summarizes recent developments in clip-based systems and endoscopic suturing platforms, as well as their expanding role in endoluminal antireflux interventions.</p> Recent Findings <p>The evolution of clip-based systems and endoscopic suturing platforms has expanded the therapeutic spectrum, allowing prompt defect closure with reduced morbidity and decreased need for surgical intervention. These innovations have positioned endoscopy as a primary modality for the treatment of procedure-related perforations, particularly in the context of increasingly complex therapeutic interventions. New-generation through-the-scope clips, over-the-scope clips, and advanced suturing systems have broadened indications for endoscopic full-thickness closure. Improved tissue capture, enhanced tensile strength, and better maneuverability have increased technical and clinical success across a range of defect sizes and challenging anatomical locations. Moreover, refinement of tissue approximation techniques has extended beyond defect closure to include novel endoluminal approaches for the management of gastroesophageal reflux disease.</p> Summary <p>Endoscopic technologies have transformed the management of post-resection closure and gastrointestinal acute perforations and have also expanded the scope of minimally invasive gastroesophageal reflux disease treatment.</p>