Prospective Evaluation of the Efficacy and Safety of Endoscopic Tissue Apposition

Inclusion Criteria: * Patients\>18 years of age undergoing endoscopy for any of the following indications: Indications for Tissue Apposition: * Closure of perforations * Closure of full thickness defects created during endoscopic full thickness resection * Closure of defects after endoscopic submucosal dissection and endoscopic mucosal resection * Closure of mucosotomy after Peroral Endoscopic Myotomy (POEM) * Stent fixation * Closure of fistulas * Natural Orifice Transluminal Endoscopic Surgery defect closures * Post-bariatric surgery gastrojejunal anastomosis and gastric pouch revision (transoral outlet repair) * Primary endoscopic sleeve gastroplasty Exclusion Criteria: * Patients unable or unwilling to provide consent * Pregnant patients * Coagulation disorders (INR \>1.8, platelet \<50,000) * GI Bleeding * Hemodynamic instability * Enrollment in another device or drug study that may confound the results