Novel through-the-scope dual-action tissue clip for mucosal defect closure after endoscopic resection of large nonpedunculated colorectal lesions: a strong stimulus for multinational collaboration

Mohammed et al1Mohammed A. Robalino Gonzaga E. Hasan M.K. et al.Low delayed bleeding and high complete closure rate of mucosal defects with the novel through-the scope dual-action tissue clip after endoscopic resection of large nonpedunculated colorectal lesions.Gastrointest Endosc. 2024; 99: 83-90.e1Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar reported a multicenter prospective cohort study using a novel dual action tissue (DAT) clip for closure of large nonpedunculated colorectal lesions (LNPCLs) after endoscopic resection (ER) in 107 patients. Complete closure with the DAT clip in conjunction with TTS clips was achieved in 96.3% of patients (1.4 ± 0.6 DAT and 2.9 ± 1.8 TTS clips). Closure with the DAT clip was comparatively associated with lower delayed bleeding rate (0.9%) than was conventional endoscopic clipping (1.5% to 9.7%).2Liaquat H. Rohn E. Rex D.K. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions.Gastrointest Endosc. 2013; 77: 401-407Abstract Full Text Full Text PDF PubMed Scopus (215) Google Scholar There is increasing interest in novel suturing technology such as the through-the-scope tack and suture system (TTSS) and the TTS suture system as good options for patients with GI wall defects, particularly in selected groups of patients who definitely require closure that cannot be sufficiently achieved with standard endoclips.3Krishnan A. Shah-Khan S.M. Hadi Y. et al.Endoscopic management of gastrointestinal wall defects, fistula closure, and stent fixation using through-the-scope tack and suture system.Endoscopy. 2023; 55 (72): 776PubMed Google Scholar,4Almario J.A. Zhang L.Y. Cohen J. et al.Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study.Endoscopy. 2023; 55: 865-870Crossref PubMed Scopus (3) Google Scholar Recently, Almario et al4Almario J.A. Zhang L.Y. Cohen J. et al.Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study.Endoscopy. 2023; 55: 865-870Crossref PubMed Scopus (3) Google Scholar evaluated the rates of delayed bleeding and complete defect closure using a novel TTS suturing system for the closure of duodenal EMR defects. Complete closure was achieved in 100% of cases without any case of delayed bleeding.4Almario J.A. Zhang L.Y. Cohen J. et al.Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study.Endoscopy. 2023; 55: 865-870Crossref PubMed Scopus (3) Google Scholar However, in comparison with these devices, closure with the DAT clip seems to be simpler and more promising, especially for large defects (≥20 mm). Some issues still need further investigation. (1) The authors did not report closure times with the DAT clip with or without TTS, which may carry a longer procedure time compared with simple endoscopic clipping. (2) No methods of cost analysis were given; as the authors reported, a major limitation of the DAT may be the cost. (3) Although they reported the procedural characteristics and clinical outcomes in detail, it is difficult to interpret those details without a reference for comparison. (4) Currently, this technology is available only in the United States,1Mohammed A. Robalino Gonzaga E. Hasan M.K. et al.Low delayed bleeding and high complete closure rate of mucosal defects with the novel through-the scope dual-action tissue clip after endoscopic resection of large nonpedunculated colorectal lesions.Gastrointest Endosc. 2024; 99: 83-90.e1Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,5Yang D. Kadkhodayan K. Arain M.A. et al.Novel dual-action tissue through-the-scope clip for endoscopic closure.VideoGIE. 2022; 7: 345-347Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar which is a major drawback and should act as a strong stimulus for multinational collaboration for the advancement of such interventional endoscopic techniques. All authors disclosed no financial relationships.