Through-the-scope tack application for defect closure following endoscopic submucosal dissection

Effective closure of both muscular and mucosal defects after endoscopic submucosal dissection (ESD) remains a technical challenge. Failure to adequately address such defects may increase the risk of delayed perforation. In this video case report, we demonstrate the application of the through-the-scope (TTS) tack system for defect closure following ESD in a patient with a cecal lesion. The patient, a 79-year-old male, presented with a 75-mm laterally spreading sessile lesion in the cecum identified during screening colonoscopy. ESD was performed successfully, revealing a partial defect in the muscular layer. To address the risk of complications associated with this defect, we utilized the X-Tack (TM) endoscopic heliX tacking system (Apollo Endosurgery, Inc., Austin, TX, USA) to achieve secure closure of both the mucosal and muscular layers. The procedure was completed without complications, and the patient was discharged on the same day. This case highlights the feasibility and safety of the TTS tack system for the closure of combined mucosal and muscular defects after ESD, particularly for right-sided colonic lesions.