ASGE DDW Videos from Around the World | 2026-CAUGHT BETWEEN A ROCK AND A HARD PLACE

CAUGHT BETWEEN A ROCK AND A HARD PLACE - TROUBLESHOOTING TO GET OUT OF A JAM

Video Transcription

Video Summary

A 63-year-old woman with end-stage achalasia and a megaesophagus underwent an endoscopic POPE procedure to reduce a distal esophageal sump. During the first suture pass, a previously placed through-the-scope clip became jammed in the suturing device’s needle-guard gap, trapping tissue and preventing needle release. A slim gastroscope identified the obstruction and enabled electrosurgical incision to free the device. The resulting defect was closed endoscopically, and the POPE procedure was then completed with five sutures. Follow-up esophagram showed no leak and improved emptying. This case highlights a rare suturing-device malfunction and a method for safe rescue.

Asset Subtitle

Submitted by Davekaran Buttar

Keywords

achalasia

megaesophagus

endoscopic suturing malfunction

POPE procedure

esophageal defect closure