Commentary

Through-the-scope (TTS) clips are ideal for managing iatrogenic perforation during endoscopic resection as these clips can be applied immediately without the need for any additional preparation. When there is a large defect or when there is surrounding fibrosis, it can be challenging to capture and appose the two edges of the perforation securely using TTS clips. TTS clips with nylon purse-string suturing, over-the-scope (OTS) clips, and endoscopic suturing devices have been used to overcome such challenges. However, these other techniques require additional preparation time and are more cumbersome to use than TTS clips.

The through-the-scope twin clip (TTS-TC) is a novel device that can overcome the current limitations of standard TTS clipping [1].The device is rotatable and can be opened and closed repeatedly. A fixed support column between the clip arms on either sides of the TTS-TC allows independent opening, clamping, and closing of each side. To close a perforation, the clip on one side of the TTS-TC is first used to capture one margin of the perforation, and then the clip on the other side is used to capture the opposite margin. Then both edges are then brought together securely, and the clips are deployed.

This is a welcome addition to our therapeutic armamentarium. It has the potential to achieve efficient closure of large perforations in difficult locations, as illustrated in this case of closure of a duodenal perforation [2].

Publication History

Article published online:
27 July 2023

• References

• 1 Zhang Q, Jin HY, Shen ZH. et al. Novel through-the-scope twin clip for the closure of GI wounds: the first experimental survival study in pigs (with videos). Gastrointest Endosc 2021; 94: 850-858
• 2 Ma X, Yang L, Yu D. et al. Complete sealing of a duodenal perforation during endoscopic submucosal dissection using a novel through-the-scope twin clip. Endoscopy 2023; 55: E505-E506