BRIEF RESEARCH REPORT article
Front. Med.
Sec. Gastroenterology
This article is part of the Research TopicInnovations and Impacts of Super-Minimally Invasive Surgery Across Surgical DisciplinesView all 4 articles
Efficacy and safety of through-the-scope twin clip for endoscopic closure of gastrointestinal defects
Provisionally accepted
Chenyang Li1
Yan Xu2Zhongrui Xu2Yujie Feng2Tao Wang1Fuxiu Huang2Ningning Zhang2Chuangxin Zhang3Sang Zhou4
Shuling Li1Chao Chen1*- 1Department of Gastroenterology, 1st Medical Center of Chinese PLA General Hospital, Beijing, China
- 2Department of Gastroenterology, Fourth Medical Center of PLA General Hospital, Beijing, China
- 3Department of Anesthesiology, Fourth Medical Center of PLA General Hospital, Beijing, China
- 4Department of Cardiology, Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
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Background and Aims The widespread adoption of endoscopic therapy has made the closure of gastrointestinal defects a critical limiting factor for its advancement. Recently, a novel device—the through-the-scope twin clip (TTS-TC)—has been introduced for endoscopic defect closure. This study aimed to evaluate the safety and efficacy of TTS-TC. Methods A retrospective observational study was conducted at a territory center, involving patients who underwent endoscopic closure using the TTS-TC from February 2023 to December 2023. The TTS-TC features an additional fixed support column centrally positioned between the bilateral metal clips, enabling independent operation. We collected data on patient demographics, lesion characteristics, endoscopic closure time, procedural outcomes, and post-procedural outcomes, including adverse events. Results Among the 36 recruited patients (22 male, 14 female), the mean age was 61±12 years. Most interventions were performed in the stomach (61.1%). Indications for clip application included hemostasis of acute ulcer bleeding (n=2), closure of perforations (n=6), and deep-wall lesions (n=28). Successful TTS-TC placement was achieved in all 36 patients (36/36). The mean maximum lesion size was 3.5±1.0 cm, with a mean procedural time of 3.5±1.8 minutes. The mean postoperative hospital stay was 5.7±3.0 days. Full-thickness resection was associated with more adverse events compared with the non-FTR group, including intraprocedural perforation, abdominal pain, and fever (p<0.001). No clip-related adverse events were observed. Conclusions The TTS-TC emerges as a promising tool for the closure of diverse gastrointestinal defects, offering a new dimension in endoscopic management.
Keywords: Defect closure, dual action tissue clip, endoscopic closure, Endoscopic surgeries, Through-the-scope twin clip
Received: 24 Oct 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Li, Xu, Xu, Feng, Wang, Huang, Zhang, Zhang, Zhou, Li and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chao Chen
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