Abstract
Background and study aims Limited comparative data exist to guide optimal through-the-scope (TTS) clip selection.
The aim of this study was to compare the efficacy, retention, and safety of three
industry-leading TTS clips on tissue that mimics common clinical scenarios.
Methods A survival study involving six domestic pigs was undertaken. Three commonly used
clip models were selected: Assurance (STERIS, Mentor, Ohio, United States), Resolution
(Boston Scientific, Boston, Massachusetts, United States), and SureClip (Micro-Tech,
Ann Arbor, Michigan, United States). To mimic clinical practice, the following scenarios
were assessed: (1) normal mucosa; (2) cold snare resection; and (3) hot mucosal resection
simulating fibrotic ulcers. Deployment of clips was randomized to target sites. Repeat
endoscopy was performed 2 weeks following placement. Endoscopists rated the ease of
use of clip placement on a Likert scale of 1 to 5.
Results Fifty-four clips (18 Assurance, 18 Resolution, and 18 SureClip) were placed in six
pigs. Mucosal healing was noted at all sites on follow up. Overall retention was nine
of 18 (50.0%) SureClip, 10 of 18 (55.6%) Assurance, and 13 of 18 (72.2%) Resolution
(P=0.369). There was no difference in clip retention on normal and cold snare resection
sites; however, clip retention was significantly higher for Resolution clips on fibrotic
ulcers (50.0% versus 0% for Assurance and 0% SureClip, P=0.03). No adverse events were reported. Ease of use was equivalent across all models.
Conclusions All clips were equivalent in efficacy and safety with successful clip deployment
and mucosal healing. Overall retention rate was low for fibrotic tissue, with an improved
retention rate observed with Resolution clips.
Keywords
Endoscopic resection (ESD, EMRc, ...) - Endoscopic resection (polypectomy, ESD, EMRc,
...) - Non-variceal bleeding
