A novel through-the-scope twin endoclip (TTS-TC) has been developed by our team. The
TTS-TC can be delivered directly through an endoscope working channel of 3.2 mm in
diameter and contributes to the closure of large mucosal wounds.
A living pig (Feed Research Institute, Guangzhou City, China) weighing 30.5 kg was
used to conduct the experiment in vivo. A QF-260 J gastroscope (Olympus, Tokyo, Japan)
was used. TTS-TC was used to reduce the size of the mucosal wound after endoscopic
submucosal dissection (ESD) ([Video 1 ]).
Video 1 A novel through-the-scope twin endoclip for closure of a large mucosal wound in a
live pig model.
The operation steps were as follows. First, the TTS-TC was delivered to the site of
the ESD wound through the endoscope working channel ([Fig. 1 a ]). The clip on one side of TTS-TC was opened by operating the handle of the TTS-TC
system, followed by tight clamping of mucosal tissue on one side of the wound ([Fig. 1 b ]). Then, the clamped tissue was pulled toward the opposite side of the wound ([Fig. 1 c ]), and the second clip on the TTS-TC was opened to clamp the mucosal tissue on this
side of wound ([Fig. 1 d ]). After the two sides of the wound had been clamped together, the TTS-TC was released
and the wound was closed ([Fig. 1 e ]). Using this TTS-TC technique, the large wound on the anterior wall of the greater
curvature of the stomach was successfully turned into two smaller wounds. After using
a TTS-TC, the wound size decreased, and TTS-TC or traditional through-the-scope clips
(TTSC) could subsequently be used to close the wound conveniently.
Fig. 1 A large wound after endoscopic submucosal dissection was successfully turned into
two smaller wounds by the use of the through-the-scope twin endoclip (TTS-TC). a The TTS-TC was delivered to the site of the wound through the endoscope working channel.
b The mucosal tissue on one side of the wound was clamped using the TTS-TC. c The clamped tissue was then pulled across to the opposite side of the wound, and
the second TTS-TC was used to clamp the tissue on this side. d, e The mucosae on both sides of the wound were clamped together; the head-end part of
the TTS-TC was then released.
The size of the wound in the current case was 3.4 × 3.3 cm. The currently available
through-the-scope clips can only close a wound of < 2 cm [1 ], and the over-the-scope-clip requires installation on the outside of the endoscope
tip and sometimes the endoscope may need to be reinserted [2 ]
[3 ]. The TTS-TC device seems to be simple and rapid in operation, and can be used to
close a large mucosal wound.
Endoscopy_UCTN_Code_TTT_1AQ_2AJ and Endoscopy_UCTN_Code_TTT_1AO_2AD
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a highhttps://mc.manuscriptcentral.com/e-videos
