Endoscopic suturing device with suture management

An endoscopic tissue suturing device may include a suturing head configured to capture tissue at a tissue capture region. A needle can move through the region to place stitches in the tissue. A control handle includes an actuator coupled to the needle. The control handle supports a suture spool about an axis of rotation. The axis of the spool may be parallel to the direction of movement of the actuator. The spool surface may be tapered at an angle relative to the axis of rotation. A spool end wall may be configured to urge the spool in an axial direction. The handle may provide external access to a portion of the suture. A cover may be provided to cover the spool. The cover may be rotatably supported on the handle independent of the spool. Suture material may be wound onto the spool by rotating the cover.