Reply to Jia et al.

We thank Jia and Yang [1] for their interest and insightful comments regarding our recent article “Endoscopic management of gastrointestinal wall defects, fistula closure, and stent fixation using through-the-scope tack and suture system” [2]. We acknowledge that our study had limitations, such as the absence of procedure time for closing gastrointestinal wall defects and the unfeasibility of robust cost comparison in this single-arm study. We agree that further large comparative studies are necessary.

We reported using through-the-scope suturing (TTSS) for the closure of gastrointestinal wall defects, which are difficult to close using standard endoscopic clips alone. In our experience, using TTSS can approximate the margins of irregular and large defects and allow closure with fewer clips in the TTSS + clip closure method. For cost analysis, we estimated the cost based on the charge of devices available to us. As we discussed, the cost of one through-the-scope (TTS) clip ranges from US $150–250, whereas a TTSS device ($695 /device) achieves cost parity with approximately four TTS clips [2]. However, we agree that further research evaluating the cost-effectiveness of the device should be addressed to denote the economic impact of this intervention compared with other closure devices.

Regarding complications with the use of TTSS and after the treatment, we recorded the adverse events (AEs) as either general or related to TTSS. During the procedure, we observed AEs such as bleeding, perforation, infection, or device-related matters such as tack migration or misplacement. Patients were instructed to report any symptoms, such as abdominal pain, fever, or bleeding, which may indicate a complication related to the procedure. In addition, clinical success and AEs were noted on follow-up visits. We categorized the AEs using the American Society for Gastrointestinal Endoscopy lexicon [3]. Mild AEs were defined as symptoms requiring postprocedural medical attention, and moderate AEs were defined as those that needed repeat endoscopy.

We are delighted by the readers’ interest in our study, and we look forward to further exploring the role of TTSS to address these limitations in our near future studies. We thank Jia and Yang [1] for their valuable critique of our study. This is an important area of research, and larger, comparative prospective trials must confirm our findings.

Publication History

Article published online:
27 September 2023

• References

• 1 Jia L, Yang S. Using a through-the-scope tack and suture system in patients with gastrointestinal wall defects: an alternative option beyond endoscopic clipping. Endoscopy 2023; 55: 973
• 2 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; DOI: 10.1055/a-2019-3652.
• 3 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454