Efficacy and Safety of Endoscopic Clousure of Gastrointestinal Fistulas Using a New Endoscopic Suturing System (X-Tack) in Colombia: A Case Series

Abstract

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 therapy has become a first-line treatment strategy for colorectal anastomotic leaks and fistulas. In esophageal and gastric fistulas, esophageal stents remain a widely used alternative, although their tolerability may be limited by the location of the defect. The X-Tack™ endoscopic suturing system (Boston Scientific), introduced in 2020, enables closure 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 defects were located in 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 for defect management.

Results. The mean patient age was 56.5 years, and 62.5% were male. The esophagus was the most frequent location (50%). The predominant suture pattern was the “Z” configuration (87.5%). Endoscopic closure of the anatomical defect was successfully achieved in all cases, with no procedure-related adverse events and complete 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 enabled successful closure of all treated defects without procedure-related complications and with clinical resolution, suggesting that it may represent a feasible and safe therapeutic option in selected patients. Prospective studies including larger numbers of patients are needed to better define its role within the therapeutic algorithm for gastrointestinal fistulas.