Efficacy, feasibility, and safety of endoscopic double closure in the GI tract.

Endoscopic closure is an important technique with prophylactic and therapeutic indications. In certain situations, performing a dual-modality closure might be justified over using a single-closure modality to achieve a more secure closure or to close a large defect more efficiently. Here we present 6 cases where dual-modality closure was used in a variety of indications in the upper and lower GI tracts. Efficacy was noted in all cases, and no adverse events were seen. This work highlights the feasibility, versatility, and safety of dual-modality closure using the endoscopic Helix Tacking System (X-Tack; Apollo Endosurgery, Austin, Tex, USA) to facilitate dual-modality closure in a variety of indications such as persistent gastrocutaneous fistulas and prevention of delayed bleeding after resection of high-risk lesions. Head-to-head prospective studies are needed to compare the outcomes and cost-effectiveness of dual-modality closure versus single-modality closure.