Post written by Shou-jiang Tang, MD, from the Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.

Endoscopic management of gastrointestinal fistula and leak is increasingly utilized. One of the options is to apply over-the-scope (OTS) clipping devices to close the defect. During pulling the grasped walls into the plastic hood, we need to obtain an optimal amount of the wall tissue. The amount of tissue secured by the twin grasper and tissue anchor is often limited compared to that by a tissue grasper. We describe that using 2tissue graspers can further increase the tissue volume on each side of the fistula opening obtained during OTS clip deployment. The authors present 3consecutive cases of gastric fistula that were managed by OTS clipping after utilizing a novel double-channel and double-grasper technique.

The authors propose that the double-channel double-grasper technique can be used to assist optimal OTS clip deployment. The limitations of this technique are: 1) not every endoscopy unit has a double-channel endoscope, 2) slightly decreased endoscope maneuverability due to the increased scope diameter and flexibility. Future development can include an added over-the-scope channel and a tissue-grasper device to assist clip deployment if a single channel endoscope is used.

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