Endoscopic Clipping with a New Rotatable Clip‐Device and a Long Clip

Abstract

Abstract: We developed a rotatable, highly durable clipping device (rotatable clip‐device) and a long clip which can be used to effectively grasp a large bite of tissue. However, application of the long clip required a special reinforced clipping device. The new rotatable clip‐device can be appropriately used in combination with the long clip because of its improved strength and rotatability. The rotatable clip‐device was used for endoscopic treatment of 133 patients, including 43 requiring hemostasis of gastrointestinal bleeding, 43 with prophylactic clipping following polypectomy, 39 with mucosal closure following endoscopic mucosal resection (EMR), and 10 undergoing prophylactic ligation of esophageal varices. The long clips were used mainly for mucosal closure after EMR. The rotatable clip‐device was found to be especially useful for hemostasis of soft bleeding lesions. Prophylactic clipping following polypectomy prevented complications in 40 out of 41 patients. Mucosal closure by means of clipping following EMR prevented complications in all 39 patients, and the rotatability of the rotatable clip‐device and the large bite capacity of the long clip greatly facilitated closing mucosal defects, especially large defects. In the 10 patients who underwent prophylactic clipping of esophageal varices, the rotatable clip‐device allowed the varices to be grasped securely and ligated effectively. During endoscopic treatment, three of the four clip‐devices functioned normally despite frequent auto‐claving and clipping procedures.