Through-the-scope twin clip for endoscopic closure of gastrointestinal defects: efficacy, safety, and factors influencing closure speed

Abstract Background and aims This study aimed to evaluate the efficacy, safety, and factors influencing closure speed of the through-the-scope twin clip (TTS-TC) for endoscopic defect closure. Methods A retrospective observational study was conducted at a single center, involving patients who underwent endoscopic closure using the TTS-TC from December 2022 to December 2024. Results TTS-TC was successfully deployed in all 78 patients, yielding a complete closure rate of 98.7% (78/79 defects). The median defect area was 10.5 (6.3–15.8) cm 2 . Median procedure time was 15.0 (10.0–19.0) min, corresponding to a median closure speed of 0.73(0.45, 1.07) cm 2 /min. Univariate and multivariate analyses identified operator experience and defect area as independent factors of closure speed. Early complications included local peritonitis in 3.8% (3/78) and infection in 1.3% (1/78); delayed bleeding and long-term adverse events did not occur. Conclusions The TTS-TC emerges as a promising tool for the closure of diverse gastrointestinal defects, offering a new dimension in endoscopic management. Graphical abstract