Abstract
A 70-year-old woman with a laterally spreading periampullary tubulovillous adenoma underwent piecemeal EMR by use of a duodenoscope. Post-EMR closure of the defect was accomplished with the X-Tack suturing device (Apollo Endosurgery, Austin, Tex, USA) through the same endoscope. HeliX tacks easily passed through the duodenoscope channel and were anchored onto the targeted tissue without any difficulty. Tack placements were positioned precisely by controlling the elevator, adding an extra element of stability and accuracy.
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