Initial multicenter experience using a novel endoscopic tack and suture system for challenging GI defect closure and stent fixation (with video)

Abstract

Background and Aims: Closure of endoscopic resection defects can be achieved with through-the-scope clips, over-the-scope clips, or endoscopic suturing. However, these devices are often limited by their inability to close large, irregular, and difficult-to-reach defects. Thus, we aimed to assess the feasibility and safety of a novel through-the-scope, suture-based closure system developed to overcome these limitations.Methods: This was a retrospective multicenter study involving 8 centers in the United States. Primary outcomes were feasibility and safety of early use of the device. Secondary outcomes were assessment of need for additional closure devices, prolonged procedure time, and technical feasibility of performing the procedure with an alternative device(s).Results: Ninety-three patients (48.4% women) with mean age 63.6 AE 13.1 years were included. Technical success was achieved in 83 patients (89.2%), and supplemental closure was required in 24.7% of patients (n Z 23) with a

Endoscopic tacking system as a novel tissue approximation measure for very large EMR defects

“…According to a recent multicenter study of 93 patients, technical success of the HeliX tacking system for intended use was 90.0%, 92.3% and 86.3% in lesions <20, 20 to 30, and >30 mm in diameter, respectively. 11 Although the ideal closure pattern has not yet been studied, similar to Zhang et al's observation, we also favored a z-pattern (zig-zag) placement of HeliX tacks for linear-and crescent-shaped defects and a figure 8 pattern for circular defects. It is essential to apply enough tension over the suture for tack approximation before cinching without breaking the suture.…”

Helix tack suspension for esophageal stent fixation

“…Costs are also a consideration, with the cost of OTS suturing devices being twice that of TTS helix tack suturing. 12 Endoscopic TTS suturing has been recently described with placement through the stent covering. 12 Our technique differs in that the removal suture is targeted, which is a potentially useful strategy when ease of removal is a priority.…”

“… 12 Endoscopic TTS suturing has been recently described with placement through the stent covering. 12 Our technique differs in that the removal suture is targeted, which is a potentially useful strategy when ease of removal is a priority. Use of a TTS suturing device for stent fixation may provide improved efficacy compared to TTS clips, improved patient comfort compared to external fixation and decreased costs, and easier removability compared to OTS clips.…”

“…Early reports suggest helix tacks remain in place for weeks to months. 12

Figure 1 Esophageal stricture before stenting.

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Palliation of Malignant Dysphagia: Dilation, Stents, Cryoablation or PDT: The GI Perspective

“…44 Newer instruments such as the over-the-scope clip and through-the-scope helical tack and suture device have been employed for stent fixation, though studies are limited. 45,46 Last, it is important to counsel all patients who receive an ES to remain on a stent-friendly diet and on proton pump inhibitors, especially if the stent crosses the gastroesophageal junction, to reduce reflux symptoms.…”