Download PDF
Open Access
CC BY 4.0 · Endosc Int Open 2026; 14: a27734910
DOI: 10.1055/a-2773-4910
Original article

Through-the-scope clip with anchor prongs for defect closure following myotomy, resection, anti-reflux mucosectomy, fistula management, or bleeding

Authors

  • Jeffrey D. Mosko

    1   Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada

  • Mohammad Al-Haddad 

    2   Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, United States

  • Heiko Pohl

    3   Section of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States

  • Nikhil A. Kumta

    4   Division of Gastroenterology and Hepatology, NYU Langone Health, New York, United States (Ringgold ID: RIN12297)

  • Shannon Melissa Chan 

    5   Department of Surgery, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong (Ringgold ID: RIN71024)

  • Marvin Ryou

    6   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, United States

  • Zaheer Nabi

    7   Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Ringgold ID: RIN78470)

  • Ping-Hong Zhou

    8   Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)

  • Haruhiro Inoue

    9   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan

  • Joyce A. Peetermans

    10   Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States (Ringgold ID: RIN5724)

  • Matthew J. Rousseau

    10   Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States (Ringgold ID: RIN5724)

  • Daniel von Renteln 

    11   Division of Gastroenterology, University of Montreal, Montreal, Canada

Supported by: Boston Scientific Corporation

Clinical Trial:

Registration number (trial ID): NCT05653843, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Multicenter, prospective cohort study


Further Information
Also available at
  Permissions and Reprints

Abstract

Background and study aims

Through-the-scope endoscopic clips (TTSCs) are essential for defect closure. A newly designed TTSC with anchor prongs can close defects that were challenging with standard TTSCs. We assessed the safety and efficacy of the TTSC with anchor prongs.

Patients and methods

We prospectively studied defect closure using a TTSC with anchor prongs within a multicenter cohort study at 10 sites in six countries. Outcomes were rates of complete defect closure, delayed bleeding, and device- or procedure-related serious adverse events (SAEs).

Results

Fifty lesions among 49 participants were studied. Mean age was 55.6 ±16.6 years, and 24 (49.0%) were male. Indications for closure included endoscopic myotomy procedures (n = 21 lesions, 42.0%), bleeding (n = 9, 18.0%), full-thickness resection (n = 7, 14.0%), submucosal tunneling endoscopic resection (n = 6, 12.0%), endoscopic antireflux mucosectomy (n = 3, 6.0%), perforation or closure of non-bleeding fistula (n = 2, 4.0%), and defect closure after removal of embedded plastic biliary stent (n = 2, 4.0%). Complete defect closure was achieved in 49 lesions (98.0%). No delayed bleeding occurred 30 days after the index procedure. Three patients (6.0%) had four related SAEs: ischemic colitis in a participant with a bleeding colonic fistula (1), submucosal leak in a peroral endoscopic myotomy (POEM) procedure (1), and septic shock and mucosal injury associated with a gastric POEM procedure (1). All related SAEs resolved by 10 days after onset.

Conclusions

The newly designed TTSC with anchor prongs demonstrated safety and efficacy in defect closures after submucosal interventions, with high rates of successful defect closure and no delayed bleeding. (ClinicalTrials.gov number, NCT05653843)

Keywords

Endoscopy Upper GI Tract - POEM - Motility/achalasia - Non-variceal bleeding


Publication History

Received: 12 March 2025

Accepted after revision: 15 December 2025

Accepted Manuscript online:
16 December 2025

Article published online:
27 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Jeffrey D. Mosko, Mohammad Al-Haddad, Heiko Pohl, Nikhil A. Kumta, Shannon Melissa Chan, Marvin Ryou, Zaheer Nabi, Ping-Hong Zhou, Haruhiro Inoue, Joyce A. Peetermans, Matthew J. Rousseau, Daniel von Renteln. Through-the-scope clip with anchor prongs for defect closure following myotomy, resection, anti-reflux mucosectomy, fistula management, or bleeding. Endosc Int Open 2026; 14: a27734910.
DOI: 10.1055/a-2773-4910
 

  • References

  • 1 Aslanian HR, Sethi A. ASGE Technology Committee. et al. ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VideoGIE 2019; 4: 343-350
    Search in Google Scholar
  • 2 Rajan E, Wong Kee Song LM. Endoscopic full thickness resection. Gastroenterology 2018; 154: 1925-1937 e1922
    Search in Google Scholar
  • 3 Thompson CC, Jirapinyo P. Bariatric endoscopic antral myotomy: a pilot study assessing technical feasibility, physiologic changes, and preliminary efficacy. Gastrointest Endosc 2024; 100: 741-744
    Search in Google Scholar
  • 4 Dalal I, Andalib I. Advances in endoscopic resection: a review of endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER). Transl Gastroenterol Hepatol 2022; 7: 19
    Search in Google Scholar
  • 5 Werner YB, Hakanson B, Martinek J. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 2019; 381: 2219-2229
    Search in Google Scholar
  • 6 Rodriguez de Santiago E, Sanchez-Vegazo CT, Penas B. et al. Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis. Endosc Int Open 2021; 9: E1740-E1751
    Search in Google Scholar
  • 7 Venkat M, Visrodia K. Management of adverse events of submucosal endoscopy. Gastrointest Endosc Clin N Am 2023; 33: 183-196
    Search in Google Scholar
  • 8 Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc 2018; 87: 4-17
    Search in Google Scholar
  • 9 Garg R, Mohammed A, Singh A. et al. Anti-reflux mucosectomy for refractory gastroesophageal reflux disease: a systematic review and meta-analysis. Endosc Int Open 2022; 10: E854-E864
    Search in Google Scholar
  • 10 Pannala R, Abu Dayyeh BK. ASGE Technology Committee. et al. Per-oral endoscopic myotomy (with video). Gastrointest Endosc 2016; 83: 1051-1060
    Search in Google Scholar
  • 11 Wei MT, Friedland S. Use of anchor pronged clips to close complex polyp resection defects. VideoGIE 2023; 8: 245-246
    Search in Google Scholar
  • 12 Kubota Y, Nishiyama R, Sasaki M. et al. Fixation of an esophageal stent using a novel re-openable endoclip for a tracheoesophageal fistula. DEN Open 2024; 4: e342
    Search in Google Scholar
  • 13 Furukawa K, Furune S, Hirose T. et al. Suturing of a mucosal defect after gastric endoscopic submucosal dissection using a combination of an anchor pronged clip and conventional clips. Rev Esp Enferm Dig 2025; 117: 526-528
    Search in Google Scholar
  • 14 Nishiyama N, Matsui T, Nakatani K. et al. Novel strategy of hold-and-drag clip closure with mantis-like claw for post-gastric endoscopic submucosal dissection defect of <30 mm. Endoscopy 2023; 55: E1244-E1245
    Search in Google Scholar
  • 15 Shigeta K, Kawata N, Ono H. Novel clip closure technique for a large mucosal defect with anchor-pronged clips after duodenal endoscopic submucosal dissection. Dig Endosc 2024; 36: 849-850
    Search in Google Scholar
  • 16 Mizutani H, Tsuji Y, Hisada H. et al. Successful closure of gastric wall defect after endoscopic full-thickness resection using novel anchor pronged clips: a case report. Endoscopy 2023; 55: E1234-E1235
    Search in Google Scholar
  • 17 Yoshida N, Hirose R, Dohi O. et al. A novel reopenable clip with sharp claw for complete closure of mucosal defects after colorectal endoscopic submucosal dissection. Endoscopy 2025; 57: 354-360
    Search in Google Scholar
  • 18 US Food and Drug Administration. 510(k) number K221124: Mantis Clip (August 4, 2022). https://www.accessdata.fda.gov/cdrh_docs/pdf22/K221124.pdf
  • 19 Boston Scientific Corporation. Directions for use: MANTIS Clip. https://www.bostonscientific.com/content/dam/bostonscientific/endo/portfolio-group/mantis/MANTIS_Short_DFU_16Sep2022.pdf
  • 20 Yang D, Xiao Y, Draganov PV. Novel devices for third-space endoscopy procedures. Dig Endosc 2024; 36: 521-532
    Search in Google Scholar
  • 21 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
    Search in Google Scholar
  • 22 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    Search in Google Scholar
  • 23 International Organization for Standardization, Geneva, Switzerland. ISO 14155:2011 (revised by ISO 14155:2020). Clinical investigation of medical devices for human subjects: Good clinical practice. https://www.iso.org/standard/45557.html
  • 24 [Anonymous]. European Commission Directorate General for Health and Consumers. MEDDEV 2.7/3 Guidelines on Medical Devices: Clinical Investigations: Serious Adverse Event Reporting under Directives 90/385/EEC and 93/42/EEC (December 2010). http://www.meddev.info/_documents/2_7_3_en.pdf
  • 25 Sumiyama K, Gostout CJ, Rajan E. et al. Submucosal endoscopy with mucosal flap safety valve. Gastrointest Endosc 2007; 65: 688-694
    Search in Google Scholar
  • 26 Pasricha PJ, Hawari R, Ahmed I. et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 2007; 39: 761-764
    Search in Google Scholar
  • 27 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
    Search in Google Scholar
  • 28 Ponds FA, Fockens P, Lei A. et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: A randomized clinical trial. JAMA 2019; 322: 134-144
    Search in Google Scholar
  • 29 Ichkhanian Y, Abimansour JP, Pioche M. et al. Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial. Endoscopy 2021; 53: 462-468
    Search in Google Scholar
  • 30 de Moura ETH, Jukemura J, Ribeiro IB. et al. Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial. World J Gastroenterol 2022; 28: 4875-4889
    Search in Google Scholar
  • 31 Shimamura Y, Inoue H, Yamamoto K. et al. Advancements in minimally invasive endoscopic treatment: Navigating deeper layers for upper gastrointestinal lesion. Dig Endosc 2024; 36: 1094-1104
    Search in Google Scholar