Although endoscopic procedures are safe, they carry a risk of perforation, which can manifest severe adverse events for patients if not managed expediently. Endoscopic methods of closure include clips, injectable agents, and suturing devices. Occasionally, perforations occur in difficult locations. Recently, a through-the-scope tacking system, X-tack Endoscopic HeliX Tacking System 160 cm (HTS) (Apollo Endosurgery Inc, Austin, Tex, USA), has been made available for mucosal defect closure, providing endoscopists with another tool to manage adverse events. There is emerging evidence for the use of the X-tack system in accomplishing closure of full-thickness defects. Here, we demonstrate the use of the HTS for management of a duodenal perforation during endosonographic evaluation of a pancreatic mass. The repair using the HTS was durable and allowed for EUS-guided choledochoduodenostomy (EUS-CD) to be performed.