# A Novel Endoscopic Strategy for Addressing Complex Gastrointestinal Defects via the X‐Tack System: A Case Series With Videos

## TL;DR

This paper presents a new endoscopic method using the X-Tack system to safely and effectively close complex gastrointestinal defects in challenging locations.

## Contribution

The study introduces the X-Tack through-the-scope suturing system as a novel solution for small gastrointestinal defect closure in difficult anatomical sites.

## Key findings

- Thirteen patients achieved 100% technical success with TTSS using the X-Tack system.
- 76.9% of patients showed clinical and laboratory remission at seven days and sustained remission after 2.5 months.
- The procedure was effective in challenging locations like post-surgical anastomotic leaks and narrow lumens.

## Abstract

The management of complex gastrointestinal defects (CGDs), such as fistulas, leaks, and anastomotic dehiscence, remains challenging. Over‐the‐scope suturing (OTSS) systems provide effective closure, but their application is limited to specific anatomical sites. The X‐Tack through‐the‐scope suturing (TTSS) system offers a minimally invasive alternative for CGD closure without requiring scope withdrawal. This case series evaluated patients who underwent TTSS closure for CGDs ≤25 mm at our center. All patients were assessed through computed tomography and multidisciplinary board discussion before endoscopic treatment. Endoscopic closure was performed using the X‐Tack system, applying a figure‐of‐8 or zig‐zag pattern depending on defect characteristics. Follow‐up included clinical and laboratory assessments at seven days and during long‐term observation. Thirteen patients underwent TTSS closure, achieving a 100% technical success rate. Clinical and laboratory remission at seven days was observed in 76.9% of cases, with a sustained clinical remission in 76.9% after a median follow‐up of 2.5 months. The procedure was effective even in challenging anatomical locations, including post‐surgical anastomotic leaks and narrow lumens. TTSS using the X‐Tack system is a safe and effective approach for small CGD closure, particularly in difficult anatomical sites.