A simplified strategy for stent fixation using a defect-closure system in refractory esophageal stricture

Refractory esophageal strictures due to benign conditions (such as post-radiation therapy, endoscopic resection, or caustic ingestion) are often managed with endoscopic stenting. Despite its effectiveness, stent migration remains a major limitation, with studies reporting rates of up to 40% [1]. To address this, stent fixation strategies have been developed [2]. An X-Tack defect closure system (Boston Scientific, Marlborough, MA, USA), originally designed for closure of gastrointestinal defects, has also been used for stent anchoring [3] [4]. Conventionally, the device utilizes four helical tacks, a running suture, and a cinch. We describe a simplified approach using tack-only fixation, omitting the suture to make the procedure more straightforward.

A 19-year-old patient with caustic-induced esophageal strictures, refractory to multiple dilations, underwent placement of a fully covered stent. Unfortunately, the stent migrated after 2 days and was removed. A second stent was placed and secured using the X-Tack system. After confirming correct positioning by free contrast flow into the stomach, the polypropylene suture was cut and each tack was loaded individually onto the tack-driver catheter. The first tack was advanced through the stent mesh into healthy apposing esophageal tissues ([Fig. 1]). Secure fixation was verified by the gentle traction of the device prior to release. Additional tacks were deployed in distinct areas along the proximal stent edge, ensuring stable anchorage ([Video 1]).

Fig. 1 Tacks were advanced through the stent mesh into the healthy apposing esophageal tissue.

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A simplified tack-only approach was adopted for stent fixation in a caustic-induced esophageal stricture. Tack placement along the proximal stent edge achieved secure and stable anchoring.Video 1

Four weeks later, the stent was removed, with endoscopy showing significant improvement of the stricture. The patient has since tolerated a soft diet without further intervention.

This tack-only fixation technique stabilized the stent effectively, prevented migration and simplified the procedure. By eliminating the suture component, the method offers a user-friendly and reproducible approach, potentially extending the use of the X-Tack system even to endoscopists less familiar with defect closure applications.

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Contributorsʼ Statement

Marco Spadaccini: Writing – original draft. Davide Massimi: Writing – review & editing. Giacomo Marcozzi: Writing – original draft. Matteo Colombo: Writing – review & editing. Alessandro Fugazza: Writing – review & editing. Roberto De Sire: Writing – review & editing. Alessandro Repici: Writing – review & editing.

Conflict of Interest

MS: Boston Scientific (consultancy), Olympus Corp (Speaking honorarium). MC: Boston Scientific (speaking honorarium). AF: Boston Scientific (consultancy). AR: Fujifilm (consultancy), Olympus Corp (consultancy), Medtronic Co. (consultancy), Boston Scientific (consultancy). Other authors: nothing to disclosure.

• References

• 1 Coelho-Prabhu N, Forbes N, Thosani NC. et al. Adverse events associated with EGD and EGD-related techniques. Gastrointest Endosc 2022; 96: 389-401.e1
• 2 Papaefthymiou A, Gkolfakis P, Basiliya K. et al. Success rates of fixation techniques on prevention of esophageal stent migration: a systematic review and meta-analysis. Endoscopy 2024; 56: 22-30
• 3 Krishnan A, Shah-Khan SM, Hadi Y. et al. Endoscopic management of gastrointestinal wall defects, fistula closure, and stent fixation using through-the-scope tack and suture system. Endoscopy 2023; 55: 766-772
• 4 Mahmoud T, Wong Kee Song LM, Stavropoulos SN. et al. Initial multicenter experience using a novel endoscopic tack and suture system for challenging GI defect closure and stent fixation (with video). Gastrointest Endosc 2022; 95: 373-382

Publication History

Article published online:
20 January 2026