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CC BY 4.0 · Endoscopy 2025; 57(S 01): E878-E879
DOI: 10.1055/a-2648-7419
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Closure of a large post-endoscopic full-thickness resection defect in the duodenum using a novel through-the-scope twin clip

Authors

  • Yiying Qi

    1   Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan, China (Ringgold ID: RIN611300)

  • Aihong Yin

    1   Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan, China (Ringgold ID: RIN611300)

  • Hongyan Liu

    1   Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan, China (Ringgold ID: RIN611300)

  • Zhi Wei

    1   Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan, China (Ringgold ID: RIN611300)
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A 46-year-old man was admitted to our hospital with a 2.5-cm submucosal tumor in the duodenal bulb ([Fig. 1]). Enhanced computed tomography revealed a rounded abnormal enhancement in the duodenal bulb ([Fig. 2]). Endoscopic ultrasound showed a heterogeneous hypoechoic lesion originating from the muscularis propria with both intraluminal and extraluminal growth ([Fig. 3]). A submucosal injection was performed, followed by a mucosal incision around the intraluminal component of the tumor to expose the pseudocapsule.

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Fig. 1 The tumor was located in the duodenal bulb.
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Fig. 2 Enhanced computed tomography showed a round-like abnormal enhancement in the duodenal bulb.
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Fig. 3 Endoscopic ultrasound showed a heterogeneous hypoechoic lesion originating from the muscularis propria.

Endoscopic full-thickness resection (EFTR) with 8-ring assisted traction was performed to remove the lesion, during which thick nourishing arteries were observed. The lesion was successfully resected ([Fig. 4] a), with a wound size of approximately three cm ([Fig. 4] b). A through-the-scope twin clip (TTS-TC) was used to close the full-thickness defect ([Fig. 5] a, [Video 1]). The TTS-TC was inserted through the biopsy channel of the endoscope, clamping one side of the wound while positioning the other side before releasing the TTS-TC. This process transformed the large defect into smaller ones. Subsequently, two TTS-TCs and several traditional through-the-scope clips were deployed to completely close the defect. Finally, surgical glue was sprayed on the surface of the wounds ([Fig. 5] b). The patient fasted for three days and was discharged after eight days with no postoperative complications. Histopathological analysis revealed a low-risk gastrointestinal stromal tumor (GIST).

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Fig. 4 a The excised specimen. b The duodenal wall defect after the full-thickness resection.
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Fig. 5 a The full-thickness defect sealed with a through-the-scope twin clip. b Complete sealing of wound.
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A novel through-the-scope twin clip is used to close a large post-endoscopic full-thickness resection defect in the duodenum.Video 1

Tumors originating from the muscularis propria layer and adhering to the serosal layer can be resected through EFTR. Due to the unique anatomical location of the duodenum, closing large wounds remains a significant clinical challenge. Previous reports have documented the use of endoscopic suturing systems for closing wounds following EFTR of the duodenum [1] [2]. We report the successful application of TTS-TC combined with surgical glue, which serves as an accurate, efficient, and safe method for sealing duodenal defects occurring during EFTR.

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Zhi Wei
Department of Gastroenterology, Shandong Second Provincial General Hospital
No. 4, Duanxing West Road, Huaiyin District
Jinan City, Shandong Province 250022
China   

Publication History

Article published online:
08 August 2025

© 2025. 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/).

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Zoom
Fig. 1 The tumor was located in the duodenal bulb.
Zoom
Fig. 2 Enhanced computed tomography showed a round-like abnormal enhancement in the duodenal bulb.
Zoom
Fig. 3 Endoscopic ultrasound showed a heterogeneous hypoechoic lesion originating from the muscularis propria.
Zoom
Fig. 4 a The excised specimen. b The duodenal wall defect after the full-thickness resection.
Zoom
Fig. 5 a The full-thickness defect sealed with a through-the-scope twin clip. b Complete sealing of wound.