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

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.