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CC BY 4.0 · Endosc Int Open 2026; 14: a27848740
DOI: 10.1055/a-2784-8740
Original article

Endoloop-assisted endoscopic removal of over-the-scope and full-thickness resection device clips: Prospective study

Authors

  • Tobias Blasberg

    1   Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum Offenbach GmbH, Offenbach, Germany (Ringgold ID: RIN9206)
    2   Department of Hepatology and Gastroenterology, Charité – Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Germany (Ringgold ID: RIN14903)

  • Lukas Hiebel

    3   Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany (Ringgold ID: RIN27177)

  • Moritz Meiborg

    1   Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum Offenbach GmbH, Offenbach, Germany (Ringgold ID: RIN9206)

  • Johannes Richl

    1   Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum Offenbach GmbH, Offenbach, Germany (Ringgold ID: RIN9206)

  • Florian Alexander Michael

    4   Department of Medicine I Gastroenterology Hepatology Pneumology Allergology Endocrinology Diabetology, Medical Clinic 1, University Hospital Frankfurt, Frankfurt, Germany (Ringgold ID: RIN243538)

  • Ali Seif Amir Hosseini

    5   Department of Clinical and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany (Ringgold ID: RIN27177)

  • Ahmad Amanzada

    3   Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany (Ringgold ID: RIN27177)

  • Volker Ellenrieder

    3   Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany (Ringgold ID: RIN27177)

  • Juergen Hochberger

    2   Department of Hepatology and Gastroenterology, Charité – Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Germany (Ringgold ID: RIN14903)

  • Wedi Edris

    1   Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum Offenbach GmbH, Offenbach, Germany (Ringgold ID: RIN9206)
    3   Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany (Ringgold ID: RIN27177)
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Abstract

Background and study aims

The over-the-scope (OTS) clip system is an established tool for endoscopic management of gastrointestinal bleeding, perforations, fistulas, and, in its modified form as the full-thickness resection device (FTRD), for resection of gastrointestinal lesions. In selected cases, clip removal is required. Conventional techniques often demand costly devices and may be time-consuming. This study evaluated a novel, simple technique for endoscopic removal of OTS and FTRD clips using an endoloop, focusing on feasibility and safety.

Patients and methods

This prospective single-center study included patients who had undergone OTS or FTRD clip placement and required clip removal between March 2021 and October 2024. The removal procedure involved positioning an endoloop underneath the clip. Follow-up endoscopy within 6 months assessed clip detachment. The primary endpoint was the success rate for clip removal; the secondary endpoint was incidence of adverse events (AEs).

Results

A total of 18 patients underwent endoloop-assisted removal of OTS (50%, 9/18) or FTRD (50%, 9/18) clips. Endoloop placement was performed at a median of 94 days (range: 27–472) after OTS clip placement and 97 days (range: 0–274) after EFTR. Follow-up endoscopy confirmed clip detachment after a median of 107 days (range: 33–220) for OTS and 114 days (range: 5–203) for FTRD clips. Clip removal was successful in all patients (100%), with no AEs observed.

Conclusions

Endoloop-assisted removal of OTS and FTRD clips appears to be effective and safe, representing an addition to current options for endoscopic clip removal.

Keywords

Endoscopy Upper GI Tract - Non-variceal bleeding - Ulcers (peptic and other) - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Endoscopy Lower GI Tract - Polyps / adenomas / ... - Lower GI bleeding


Publication History

Received: 03 August 2025

Accepted after revision: 08 January 2026

Accepted Manuscript online:
08 January 2026

Article published online:
06 March 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Tobias Blasberg, Lukas Hiebel, Moritz Meiborg, Johannes Richl, Florian Alexander Michael, Ali Seif Amir Hosseini, Ahmad Amanzada, Volker Ellenrieder, Juergen Hochberger, Wedi Edris. Endoloop-assisted endoscopic removal of over-the-scope and full-thickness resection device clips: Prospective study. Endosc Int Open 2026; 14: a27848740.
DOI: 10.1055/a-2784-8740
 

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