A Novel Endoscopic Strategy for Addressing Complex Gastrointestinal Defects via the X-Tack System: A Case Series With...

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopy

Background:

• Management of complex gastrointestinal defects (CGDs) like fistulas and leaks is challenging.
• Existing over-the-scope suturing (OTSS) systems have anatomical limitations.
• Through-the-scope suturing (TTSS) offers a less invasive alternative for CGD closure.

Purpose of the Study:

• To evaluate the safety and efficacy of the X-Tack TTSS system for closing small CGDs (≤25 mm).
• To assess the technical success and clinical outcomes of TTSS in various anatomical locations.

Main Methods:

• A case series of thirteen patients undergoing TTSS closure for CGDs ≤25 mm.
• Pre-procedural assessment included CT scans and multidisciplinary board review.
• X-Tack system used in figure-of-8 or zig-zag patterns; follow-up included clinical and lab assessments.

Main Results:

• 100% technical success rate for TTSS closure.
• 76.9% achieved clinical and laboratory remission at seven days.
• Sustained clinical remission in 76.9% after a median follow-up of 2.5 months.
• Effective in challenging sites like post-surgical anastomotic leaks and narrow lumens.

Conclusions:

• TTSS using the X-Tack system is a safe and effective method for closing small CGDs.
• The system demonstrates efficacy in difficult-to-reach anatomical locations.
• TTSS represents a valuable minimally invasive option for managing specific complex gastrointestinal defects.