Helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: is it ready for global adoption?

Farha et al. reported the use of a novel through-the-scope (TTS) helix tack-and-suture device for the closure of large mucosal defects after colorectal endoscopic submucosal dissection (ESD; median lesion size 30 mm, interquartile range [IQR] 25–40 mm) [1]. Technical success was achieved in 92.7 % of patients, with a median closure time of 10 minutes (IQR 6.3–17.3 minutes). A total of 32 patients required endoclip closure in addition to the TTS suturing device, and 10 patients required multiple TTS devices for mucosal closure.

The TTS suture device carries a relatively longer procedure time and a lower success rate compared with simple TTS clipping, which requires 4–6 minutes with 100 % success [2] [3]. This device is also not available in countries where the largest number of ESD procedures are performed, including China. Furthermore, a major limitation of the device may be the cost incurred, particularly when multiple devices are required, as this would not only prolong the procedure time, but also add to the time and cost of anesthesia. Malpositioning of one of the four tacks would further prolong procedure time and may even require additional suturing devices for effective closure. Finally, for colorectal ESD, the need for mucosal defect closure is a matter of debate rather than a standard of care unless there is damage to the muscularis layer or if perforation(s) are noted, in which case endoclip closure of the luminal defect with or without nylon loops is currently considered the most effective and widely available method for closure [4] [5].

While the novel TTS suturing device is certainly a welcomed expansion of the armamentarium of interventional endoscopy, in the context of colorectal ESD, this technology may better serve a select group of patients who definitively require luminal defect closure, which cannot be sufficiently achieved with endoclips. From a societal standpoint, the global adoption of this novel technology is currently hindered by availability and lack of a robust cost-effectiveness profile, which should be the subject of future investigations.

Publication History

Article published online:
27 July 2023

• References

• 1 Farha J, Ramberan H, Aihara H. et al. A novel through-the-scope helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: a multicenter study. Endoscopy 2023;
• 2 Jiang W, Cen L, Dong C. et al. Prophylactic clipping to prevent delayed bleeding and perforation after endoscopic submucosal dissection and endoscopic mucosal resection: a systematic review and meta-analysis. J Clin Gastroenterol 2022; 56: 643-653
• 3 Al-Bawardy B, Rajan E, Wong Kee Song LM. Over-the-scope clip-assisted endoscopic full-thickness resection of epithelial and subepithelial GI lesions. Gastrointest Endosc 2017; 85: 1087-1092
• 4 Zhu M, Xu Y, Yu L. et al. Endoscopic submucosal dissection for colorectal laterally spreading tumors: clinical outcomes and predictors of technical difficulty. J Dig Dis 2022; 23: 228-236
• 5 Hernandez A, Marya NB, Sawas T. et al. Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video). Endosc Int Open 2021; 9: E572-E577