Post written by Andy Storm, MD, from Mayo Clinic, Rochester, Minnesota, USA.

The availability of suture-based technologies is growing in flexible GI endoscopy, with one of the newcomers the X-Tack device (Boston Scientific, Marlborough, Mass, USA). This device, conceived with Dr Christopher Gostout and Apollo Endosurgery, uses steel “screws” or tacks that are drilled into tissue as anchors for a polypropylene suture typically running through all 4 tacks, which can then be tightened and cinched to appose and close large defects in the GI tract.

As they are modeled after fixation screw technology used in surgery for hernia repair through mesh fixation, it is not a big leap to consider using these tacks for fixation of devices beyond suture in the GI tract. The lumen-apposing metal stent, which has a unique small-wire, tight-weave design, appears to be perfectly suited for this approach–where the tacks may be drilled through the interstices of the woven nitinol wires with the goal of stent fixation to avoid early migration.

More experience with this technique is needed before recommending its routine use, but we hope you will scope out our approach to lumen-apposing metal stent fixation using tacks (but no suture!) in the October issue of VideoGIE.

First tack (white arrow) is drilled and deployed through the lumen-apposing metal stent into adjacent mucosa.

Read the full article online.

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