Post written by Mike Tzuhen Wei, MD, from Stanford University, Stanford, California, and Veterans Affairs Palo Alto, Palo Alto, California, USA.

In our presentation, we demonstrate the use of a dual-action clip and clips with atraumatic teeth in facilitating the closure of endoscopic submucosal dissection defects.

We found that the dual-action clip (Micro-Tech Endoscopy USA, Ann Arbor, Mich, USA) is ideally suited to bring distant edges of the wound together. Once the wound is partially closed, single clips with atraumatic teeth (Micro-Tech Endoscopy USA) can be used to finish the closure.

Current devices for closure of endoscopic submucosal dissection defects have limitations that include learning curve, defect size restriction, and the need to be used with specific endoscopes. The dual-action clip and clips with atraumatic teeth offer improved ease and simplicity with defect closure, making them an attractive option.

Closure of large wounds with standard clips is challenging, as the clips can easily slip off the mucosa because of excessive tension or inadequate purchase. Use of the dual-action clip can significantly reduce the size of the wound and tension on the edges. In doing so, subsequent closure becomes significantly easier, decreasing time and reducing the number of clips needed.

In addition, use of clips with atraumatic teeth offers improved defect closure and stability compared with standard through-the-scope clips, providing endoscopists more peace of mind at the end of the case.

Dual-action clip. Top: the clips are controlled independently by 2 handles. The gold clip is controlled by the yellow handle and the silver clip is controlled by the blue handle. Bottom left: opened gold clip. Bottom right: both clips opened.

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