Novel removable endoscopic clip: Usefulness in failure of traction method during endoscopic submucosal dissection

概要

Article published online: 2023-09-15
E-Videos

Novel removable endoscopic clip: Usefulness in failure of traction
method during endoscopic submucosal dissection

▶ Fig. 1 How to remove the hemoclip, a novel removable clip. a The hemoclip deployed on the mucosa. b Squeezing the thinning point at the
end of the clip stem using a polypectomy snare. c The clip being immediately detached from the mucosa.

Endoscopic clips, which are widely used
for hemostasis and closure [1, 2], have recently been applied to other indications
such as traction-assisted endoscopic submucosal dissection (ESD) [3]. Repositionable clips have been reported to be a promising option for any indication [4, 5].
Despite the adoption of clips that allow
repeated opening and closing before clip
deployment, endoscopists still encounter
situations in which they want to remove
the placed clip. Here, we present a novel
removable clip (hemoclip, AG-510442300-090-16; Hangzhou AGS MedTech
Co., Ltd., Hangzhou, China) that is repositionable and rotatable. The clip was detached by squeezing the thinning point
at the end of the clip stem using a polypectomy snare ( ▶ Fig. 1).
This video shows the usefulness of novel
removable endoscopic clips in failure of
the traction method during gastric ESD
in in vivo porcine models (▶ Video 1).
The new clip, using a clip-with-line method, accidentally grasped both the edge of
the lesion and the muscle layer, making it
difficult to continue ESD safely. However,
the mistakenly placed clip was able to be
easily removed using a polypectomy
snare (AG-5078–241023; Hangzhou AGS
MedTech Co., Ltd) ( ▶ Fig. 2). Then, a clip
with a ring-loaded spring (S-O clip,
TC1H05; Zeon Medical Co., Ltd., Tokyo,
Japan) was used for the traction method

Video 1 Demonstration of the usefulness of novel removable endoscopic clips in failure
of the traction method during endoscopic submucosal dissection in a porcine model.

during ESD. The removable clip captured
the loop part of the S-O clip and anchored
it to the gastric wall. However, the misplaced clip did not provide a good field of
vision or adequate tension in the submucosal dissection plane. The clip was
removed using a snare, and a new clip
was anchored to the proper position
(▶ Fig. 3). It is possible to perform the
procedure again using a removable clip,
even when closing the clip results in a
risky or ineffective situation.

Agatsuma Nobukazu et al. Novel removable endoscopic … Endoscopy 2023; 55: E1031–E1032 | © 2023. The Author(s).

Endoscopy_UCTN_Code_TTT_1AQ_2AD

Acknowledgments
The authors are grateful to K. Iwamoto for
assisting with shooting the video.

Funding
AMCO Inc., Tokyo, Japan

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E-Videos

[4] Wang TJ, Aihara H, Thompson AC et al.
Choosing the right through-the-scope clip:
a rigorous comparison of rotatability, whip,
open/close precision, and closure strength
(with videos). Gastrointest Endosc 2019; 89:
77–86.e1
[5] Inoue T, Kanesaka T, Ishihara R. Repositionable hemostasis clip for uncontrollable
bleeding during gastric endoscopic submucosal dissection. Dig Endosc 2020; 32:
e91–e92

▶ Fig. 2 Removal of the hemoclip, which mistakenly grasped the muscle layer in the clip-withline method. a The hemoclip accidentally grasped both the edge of the lesion and the muscle
layer. b The clip being removed from the muscle layer using a polypectomy snare. c The new
clip being deployed without grasping the muscle layer, resulting in a good field of vision and
adequate tension for endoscopic submucosal dissection.

Bibliography
Endoscopy 2023; 55: E1031–E1032
DOI 10.1055/a-2155-5377
ISSN 0013-726X
© 2023. 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, Rüdigerstraße 14,
70469 Stuttgart, Germany

▶ Fig. 3 The removal of the hemoclip allows the S-O clip traction direction to be changed
many times. a Although the hemoclip captures the loop of the S-O clip and anchors it to the
gastric wall, the traction tension is inadequate for submucosal dissection. b The hemoclip is
easily removed using a polypectomy snare. c The new clip is anchored to another site on the
gastric wall, resulting in a good field of vision and adequate tension for endoscopic submucosal dissection.

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Competing interests
AMCO Inc., Tokyo, Japan, provided financial
support for the porcine model experiment
and supplied the endoscopic clips and polypectomy snares used in this experiment.

Corresponding author

endoscopy. All papers include a high-quality

Department of Gastroenterology and

video and are published with a Creative

Hepatology, Kyoto University Graduate

Commons CC-BY license. Endoscopy

School of Medicine, 54 Kawaharacho,

E-Videos qualify for HINARI discounts and

Fax: +81-75-751-4303
tk_utsumi@kuhp.kyoto-u.ac.jp

Nobukazu Agatsuma 1 , Takahiro Utsumi1,
Hirokazu Higuchi 2, Takahiro Inoue1, Yukari

References

Tanaka1, Yuki Nakanishi 1, Hiroshi Seno 1
1

Department of Gastroenterology and
Hepatology, Graduate School of Medicine,
Kyoto University, Kyoto, Japan

2

Department of Medical Supply, Kyoto
University Hospital, Kyoto, Japan

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reporting on interesting cases
and new techniques in gastroenterological

Takahiro Utsumi, MD, PhD

Shogoin, Sakyo-ku, Kyoto 606-8507, Japan

The authors

section of the journal Endoscopy,

waivers and eligibility is automatically
checked during the submission process.
We grant 100% waivers to articles whose
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[1] Galloro G, Zullo A, Luglio G et al. Endoscopic
clipping in non-variceal upper gastrointestinal bleeding treatment. Clin Endosc 2022;
55: 339–346
[2] Zhang QS, Han B, Xu JH et al. Clip closure
of defect after endoscopic resection in
patients with larger colorectal tumors decreased the adverse events. Gastrointest
Endosc 2015; 82: 904–909
[3] Abe S, Wu SYS, Ego M et al. Efficacy of current traction techniques for endoscopic
submucosal dissection. Gut Liver 2020; 14:
673–684

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Agatsuma Nobukazu et al. Novel removable endoscopic … Endoscopy 2023; 55: E1031–E1032 | © 2023. The Author(s). ...

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