Synergistic use of endoscopic sutures and stents for managing complex upper gastrointestinal disorders

Background and Aims: Endoscopic sutures and stents are essential tools in therapeutic endoscopy, each serving distinct roles. When used synergistically, they enable innovative solutions for managing complex solutions in the management of complex GI conditions. Methods: Seven patients underwent endoscopic procedures that included the simultaneous use of endoscopic stents and sutures. Clinical scenarios included (1) a benign duodenal apex stricture treated with a lumen-apposing metal stent (LAMS) anchored via traction sutures; (2) duodenal perforation in a Roux-en-Y gastric bypass, treated with a sutured gastrogastric (GG) LAMS, and a concomitant through-the-scope duodenal fully covered self-expandable metal stent (SEMS), also secured via sutures; (3) closure of a GG fistula after LAMS removal, using a HeliX Tacking System (Boston Scientific, Marlborough, Mass, USA); (4) malignant duodenal obstruction of an uncovered stent, treated with a sutured fully covered SEMS; (5) suturing 2 side-by-side LAMSs for added stability; (6) HeliX tack to secure a LAMS before EUS-directed transgastric ERCP; and (7) suturing and closure of the proximal end of a LAMS to prevent solid debris entry. Results: Technical success was achieved in all cases without significant adverse events. Conclusions: We demonstrate the synergistic use of endoscopic sutures and stents to expand therapeutic options for patients with complex GI conditions.