Novel through-the-scope twin clip for the closure of GI wounds: the first experimental survival study in pigs (with videos)

Abstract

Background and Aims: We developed a through-the-scope twin clip (TTS-TC) for closing GI wounds. The objective of this study was to evaluate the efficacy and safety of the TTS-TC in GI wound closure.Methods: GI nonperforating and perforating wounds (!2.5 cm) were created in live pigs. TTS-TCs were used to convert the large wounds into small wounds. The remaining small wounds were closed using conventional throughthe-scope clips (TTSCs). The follow-up period was 1 month. Location and size of the wound, time of wound closure, intraoperative and postoperative adverse events, and conditions of wound healing were investigated.Results: Thirteen wounds were created in 5 live pigs, including 2 gastric nonperforating and 3 perforating wounds and 5 large intestinal nonperforating and 3 perforating wounds. The mean long and short diameters of the wounds were 4.1 (AE .9) cm and 3.4 (AE .7) cm, respectively. All wounds were successfully closed using the TTS-TCs combined with TTSCs. The total mean time for wound closure was 9.2 (AE 5.3) minutes, and the mean time for using the TTS-TCs was 3.9 (AE 4.7) minutes. During the 1-month follow-up period, no bleeding, perforation, or death occurred; all wounds healed with scar formation; and all TTS-TCs detached spontaneously. Conclusions:The TTS-TC was successfully used to close large-sized GI wounds. The TTS-TC is a promising tool for large-size wound closure under flexible endoscopy.Minimally invasive surgeries, such as endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFR), and natural orifice transluminal endoscopic surgery, are extensively used for treating GI diseases. A recent study also showed that wound closure after ESD might be useful in preventing delayed bleeding and perfo-ration. 1 Thus, wound closure is a common but challenging problem in these minimally invasive surgeries. [2][3][4] Firm and rapid closure of wounds plays an important role in patient prognosis, especially for perforating wounds. Currently, the main instruments 3-7 for wound closure while using a flexible endoscope are conventional through-the-scope Abbreviations: EFR, endoscopic full-thickness resection; ESD, endoscopic submucosal dissection; OTSC, over-the-scope clip; TTSC, through-thescope clip; TTS-TC, through-the-scope twin clip.

Gastric bypass was performed with a novel through-the-scope twin clip under endoscopy

“…A novel through-the-scope twin clip (TTS-TC) (Micro-Tech Co. Ltd., Nanjing, China) was first reported by us 1 2 . The TTS-TC is composed of a middle column and two clips on both sides.…”

Novel dual-action tissue through-the-scope clip for endoscopic closure

“…2 The Dual Action Tissue (DAT) clip (Micro-Tech Endoscopy, USA Inc, Ann Arbor, Mich, USA) is a novel TTS clip designed for endoscopic closure of large mucosal defects. Zhang and colleagues 3 recently reported the first experimental study in live pigs evaluating the safety and efficacy of the DAT clip. In all, the DAT clip effectively closed all 13 mucosal defects (mean size of 4.1 AE 0.9 cm) in 5 live pigs.…”

A novel endoscopic clip for closing a large perforating wound in a patient undergoing endoscopic full-thickness resection

“…The through-the-scope twin clip (Micro-Tech Co. Ltd., Nanjing, China), also called a dual action tissue clip, was first reported by us [1,2]. The clip can pass directly through the working channel of the endoscope to close the wound and is convenient and quick to use.…”