This article discusses the endoscopic closure of a refractory urethroanal fistula using an innovative wound closure device. Gastrointestinal (GI) fistulas are rare chronic diseases that can greatly impact a patient's quality of life. The endoscopic management of GI fistulas involves a combination of endoscopic submucosal dissection (ESD) and mechanical closure of the orifice. The authors report a case of a 29-year-old man with a refractory urethroanal fistula, and they successfully used a new flexible needle holder with a barbed suture to suture the edges of the fistula tract. This novel device allowed for effective closure in a tight area. The procedure was technically successful, with no adverse events reported. The authors suggest that this new needle holder could be added to the range of existing closure methods for gastrointestinal fistulas. [Extracted from the article]