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A novel through-the-scope twin clip traction-assisted endoscopic submucosal dissection in an in vitro pig stomach model
A novel through-the-scope twin clip (TTS-TC) was developed for the closure of large gastrointestinal tract wounds  . In the current study, we initially explored the application of TTS-TC traction-assisted endoscopic submucosal dissection (ESD) in an in vitro pig stomach model.
TTS-TC traction-assisted gastric ESD was performed as follows ([Video 1]). (i) First, the mucosa was marked at the greater curvature of the stomach, and submucosal injection was performed, followed by mucosal incision along the marked points ([Fig. 1 a]). (ii) A TTS-TC was delivered through the endoscopic working channel (3.2-mm inner diameter) into the stomach cavity ([Fig. 1 b]), and the clip on one side of the TTS-TC was opened by controlling the handle to clamp the oral side of the incised mucosa (fixed point 1) ([Fig. 1 c]). (iii) The other side of the TTS-TC was opened to clamp the mucosa of the anterior wall of the lesser curvature of the stomach on the opposite side of the incised mucosa (fixed point 2) ([Fig. 1 d]). (iv) The submucosa was fully exposed through the mutual traction between the two fixed points ([Fig. 1 e]), and an endoscopic knife was then used to dissect the submucosa.
Video 1 A example of through-the-scope twin clip (TTS-TC) traction-assisted endoscopic submucosal dissection in an in vitro pig stomach model, with subsequent closure of the wound using the TTS-TC.
Only one TTS-TC was used to complete the mucosal traction. The size of the dissected mucosa was 3.8 × 2.5 cm. The total operation time was 19.6 minutes, with the time taken to dissect the submucosa being 8 minutes. The TTS-TC did not detach from the two fixed sites during dissection of the submucosa. The wound was completely closed with one TTS-TC and three conventional through-the-scope clips (TTSCs), with the time taken for wound closure being 4 minutes. The TTS-TC is a promising device for mucosal traction to assist gastric ESD.
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23 September 2020 (online)
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- 1 Zhang Q, Wang Z, Bai Y. A novel through-the-scope twin endoclip for a large mucosal closure in a live pig model. Endoscopy 2019; 51: E372-E373
- 2 Qiang Zhang, Zhen Wang. Endoscopic closure of a large-size perforation using a novel through‐the‐scope twin endoclip in an ex vivo porcine stomach model. Dig Endosc 2020; 32: e61-e62