Uncontrolled Description of X-Tack Efficacy for Colonic EMR Defects

Uncontrolled Description of X-Tack Efficacy for Colonic EMR Defects

Douglas K. Rex, MD, MASGE, reviewing Bi D, et al. Gastrointest Endosc 2023 Mar 6.

X-Tack (Apollo Endosurgery, Austin, Texas) is a through-the-scope suturing device that can be an alternative to through-the-scope clips. No controlled trial of X-Tack versus clips has been reported.

In an uncontrolled observational study, 94 patients in 13 U.S. centers were treated with X-Tack to determine its efficacy for the closure of colonic endoscopic mucosal resection (EMR) defects. Thirty-four percent of patients were receiving anticoagulation or antiplatelet therapy that was stopped before and resumed after the procedure.

Delayed bleeding occurred in 3 patients, of whom two had cecal lesions and one had a sigmoid lesion. All 94 patients had complete closure, but 34% required supplemental clips. An average of one suture was placed, and an average of 3 clips was used in cases needing clips.

Douglas K. Rex, MD, FASGE


This study helps establish the feasibility and safety of using this through-the-scope suturing device. This device could fill a gap for the closure of lesions too large to close with clips and those in the left side of the colon since clips are ineffective in the left side. Comparative trials of efficacy, efficiency, and cost are needed.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Bi D, Zhang LY, Alqaisieh M, et al. Novel through-the-scope suture closure of colonic endoscopic mucosal resection defects. Gastrointest Endosc 2023 Mar 6. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.02.031)

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