Which clip? A prospective comparative study of retention rates of endoscopic clips on normal mucosa and ulcers in a porcine model

Through-the-scope clip retention rates and performance in a porcine model

Background and study aims Limited comparative data exist to guide optimal through-the-scope (TTS) clip selection. The aim of this study was to compare the efficacy, retention, and safety of three industry-leading TTS clips on tissue that mimics common clinical scenarios. Methods A survival study involving six domestic pigs was undertaken. Three commonly used clip models were selected: Assurance (STERIS, Mentor, Ohio, United States), Resolution (Boston Scientific, Boston, Massachusetts, United States), and SureClip (Micro-Tech, Ann Arbor, Michigan, United States). To mimic clinical practice, the following scenarios were assessed: (1) normal mucosa; (2) cold snare resection; and (3) hot mucosal resection simulating fibrotic ulcers. Deployment of clips was randomized to target sites. Repeat endoscopy was performed 2 weeks following placement. Endoscopists rated the ease of use of clip placement on a Likert scale of 1 to 5. Results Fifty-four clips (18 Assurance, 18 Resolution, and 18 SureClip) were placed in six pigs. Mucosal healing was noted at all sites on follow up. Overall retention was nine of 18 (50.0%) SureClip, 10 of 18 (55.6%) Assurance, and 13 of 18 (72.2%) Resolution ( P =0.369). There was no difference in clip retention on normal and cold snare resection sites; however, clip retention was significantly higher for Resolution clips on fibrotic ulcers (50.0% versus 0% for Assurance and 0% SureClip, P =0.03). No adverse events were reported. Ease of use was equivalent across all models. Conclusions All clips were equivalent in efficacy and safety with successful clip deployment and mucosal healing. Overall retention rate was low for fibrotic tissue, with an improved retention rate observed with Resolution clips.

Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment

Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with different structural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compression of limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing a larger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficult cases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial and permanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and results of clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

INTRODUCTION

The most commonly used treatment for advanced colorectal adenomas is endoscopic mucosal resection (EMR). The increased number of EMRs since the introduction of the screening program for colorectal cancer has resulted in an increase in EMR-related complications. This review summarizes the current knowledge for the use of clips for the treatment and prevention of complications after EMR.

AREAS COVERED

The historical development of clips is summarized and their properties are evaluated. An overview is presented of the evidence for therapeutic and prophylactic clipping for bleeding or perforation after EMR in the colon. Several clipping techniques are discussed in relation to the efficacy of wound closure. Furthermore, new techniques that will likely influence the use of clips in the future endoscopic practice, such as endoscopic full-thickness resection (eFTR) are also highlighted.

EXPERT COMMENTARY

Most research focuses on prophylactic clipping for delayed bleeding after EMR of large adenomas. We advocate a distance of 0.5-1.0 cm between aligning clips. This focus may likely shift from bleeding to perforation. Here, endoscopic treatment with through-the-scope clips and large-diameter clips may well replace surgery. The future role of clips will also depend on the further development of new endoscopic technologies, such as eFTR.

Evaluating long-term attachment of a novel endoclip in porcine stomachs: a prospective study of initial deployment success and clip retention rates at different regions of the stomachs

BACKGROUND AND AIMS

Through-the-scope endoscopic clips are widely used. Several designs of endoscopic clips are marked for different applications. However, no prior reports have been published to aid in comparing success rates of clip deployment and the retention rates at different regions of the stomachs. The aims of the article were to compare success rates of clip deployment and the retention rates at different regions of the stomachs with a novel endoclip.

METHODS

Upper endoscope was inserted into the stomach of five pigs under general anesthesia. In all animals, three regions of the stomachs (gastric fundus, gastric body, and gastric antrum) were chosen as the sites of clip application. Two clips of a novel type were placed along the same gastric site at a distance of 0.5-1 cm from each other. Animals had weekly endoscopies to quantitate clip retention.

RESULTS

Success rates of clip deployment were 70% for gastric fundus, 100% for gastric body, and 100% for gastric antrum. Clip retention rates were significantly higher with gastric body than with gastric fundus or gastric antrum at 1-8 weeks.

CONCLUSIONS

(1) For the clip device, it seems that it is difficult for the clip deployment in gastric fundus (70%) than that in the gastric body or gastric antrum (100%), but there is no statistical significance (χ (2) test, p = 0.21). (2) Clips used in the gastric body were retained significantly longer than that in the gastric fundus or gastric antrum. (3) The novel clips were safe, and no complications such as bleeding or weight loss were noted.