Efficacy and safety of through-the-scope twin clip for endoscopic closure of gastrointestinal defects

Background and aims The widespread adoption of endoscopic therapy has made the closure of gastrointestinal defects a critical limiting factor for its advancement. Recently, a novel device—the through-the-scope twin clip (TTS-TC)—has been introduced for endoscopic defect closure. This study aimed to evaluate the safety and efficacy of TTS-TC. Methods A retrospective observational study was conducted at a territory center, involving patients who underwent endoscopic closure using the TTS-TC from February 2023 to December 2023. The TTS-TC features an additional fixed support column centrally positioned between the bilateral metal clips, enabling independent operation. We collected data on patient demographics, lesion characteristics, endoscopic closure time, procedural outcomes, and post-procedural outcomes, including adverse events. Results Among the 36 recruited patients (22 male, 14 female), the mean age was 61 ± 12 years. Most interventions were performed in the stomach (61.1%). Indications for clip application included hemostasis of acute ulcer bleeding ( n = 2), closure of perforations ( n = 6), and deep-wall lesions ( n = 28). Successful TTS-TC placement was achieved in all 36 patients (36/36). The mean maximum lesion size was 3.5 ± 1.0 cm, with a mean procedural time of 3.5 ± 1.8 min. The mean postoperative hospital stay was 5.7 ± 3.0 days. Full-thickness resection was associated with more adverse events compared with the non-FTR group, including intraprocedural perforation, abdominal pain, and fever ( p 0.001). No clip-related adverse events were observed. Conclusion The TTS-TC emerges as a promising tool for the closure of diverse gastrointestinal defects, offering a new dimension in endoscopic management.