S2795 Closure of an Iatrogenic Duodenal Perforation Using a Novel Tack and Suturing System

Abstract

Introduction: The novel endosopic tack and suturing system, X-Tack endoscopic HeliX tacking system (Apollo Endosurgery, Austin, Tex, USA), is an emerging technique used for the closure of large tissue defects, but its efficacy in closure of full-thickness defects remains limited. We describe a case of a successful closure of a full-thickness iatrogenic defect in the duodenum. Case Description/Methods: We present the case of a 65-year-old female diagnosed with an iatrogenic duodenal perforation. The patient was initially referred for an upper gastrointestinal tract endoscopic ultrasound (EUS) for evaluation of an asymptomatic 6mm pancreatic tail cyst found incidentally on computed tomography (CT). The EUS was complicated by a duodenal perforation in the first portion of the duodenum. The defect was 20mm in size and was immediately repaired using the tack and suture device. The patient was admitted for observation post-procedure. She was treated with broad spectrum antibiotics to prevent intra-abdominal infection. Tight closure was confirmed by absence of oral contrast extravasation on CT imaging. Her hospital course remained uncomplicated and she was discharged on day 5 after advancing her diet. (Figure) Discussion: This case demonstrates the utility and safety of the X-Tack endoscopic suturing system for full thickness gastrointestinal perforations of the upper GI tract. Its ease of use makes it a promising technique that can become widely employed. In this case, the location of the perforation in the first portion of the duodenum makes the use of other closure devices challenging. Further data is needed to make recommendations on its routine use in the closure of full-thickness defects.Figure 1.: A: Duodenal defect B: Duodenal defect after closure.