[Efficacy and Safety of Endoscopic Clousure of Gastrointestinal Fistulas Using a New Endoscopic Suturing System (X-Tack) in Colombia: A Case Series]
Javier Alberto Preciado Aponte1, Eligio Antonio Álvarez Almanza2, Elkin Julián Suárez Angarita3
1Médico Cirujano General y Gastroenterólogo, Clínica Colsanitas y Clínica Universitaria Colombia Clínica Universitaria Colombia.
Introduction:
Gastrointestinal fistulas are uncommon but potentially severe conditions associated with infectious collections, bleeding, sepsis, malnutrition, and increased morbidity and mortality. Advances in therapeutic endoscopy have expanded the options for minimally invasive treatment. Endoscopic treatment has become a first-line therapeutic strategy for colorectal anastomotic leaks and fistulas. For esophageal and gastric fistulas, esophageal stents remain a widely used alternative; however, their tolerability may be limited by the location of the defect. The X-Tack™ endoscopic suturing system (Boston Scientific), introduced in 2020, allows for the clousure of anatomical defects through the working channel of the endoscope without requiring scope withdrawal, facilitating access to complex anatomical locations and larger defects.
Patients And Methods:
We present a case series of nine gastrointestinal fistula defects in eight patients treated in Colombia. The locations included the proximal esophagus, stomach, duodenum, colon, and rectum. In all cases, the X-Tack™ endoscopic suturing system was used as part of the therapeutic strategy employed to manage the defects.
Results:
The mean age of the patients was 56.5 years, and 62.5% were male. The most common location was the esophagus (50%). The predominant suture pattern was "Z" (87.5%). In all cases, endoscopic closure of the treated defect was achieved, with no procedure-related adverse events and clinical resolution during the reported follow-up period.
Conclusions:
In this case series, the X-Tack™ system was used as part of a multimodal therapeutic strategy for the management of complex gastrointestinal fistulas at different anatomical locations. Its use allowed for the closure of the treated defects without procedure-related complications and with clinical resolution, suggesting that it may represent a feasible and safe treatment option in selected patients. Prospective studies with a larger number of patients are needed to more precisely define its role within the therapeutic algorithm for gastrointestinal fistulas.