Endoscopic clip systems for hemostasis and defect closure in gastrointestinal endoscopy

Figure 1 Anatomy of a through-the-scope clip. A: Endoscopy clip; B: Delivery catheter system.

Figure 2 Indications of endoscopic clips. A: Mechanical tissue apposition for hemostasis in bleeding solitary rectal ulcer; B: Closure of gastrointestinal defect after endoscopic full thickness resection using a combination of through-the-scope clips and X-tack system (Boston Scientific, Marlborough, MA, United States); C: Closure of post-polypectomy defect; D: Traction during esophageal endoscopic submucosal dissection; E: Lesion localization after biopsies with additional tattoo; F: Securing stents or enteral feeding tubes. GI: Gastrointestinal; ESD: Endoscopic submucosal dissection.

Figure 3 Specialized through-the-scope clips. A: MANTIS (Boston Scientific, Marlborough, MA, United States): Anchor-pronged arms with sharp distal teeth; B: Lockado (Micro-Tech Co. Ltd., Nanjing, China): Two opposing rows of atraumatic teeth for enhanced grip; C: Dual action tissue (Micro-Tech Endoscopy, United States Inc., Ann Arbor, MI, United States): Two independently operable arms flanking a central post with dual color-coded handles. DAT: Dual action tissue.

Figure 4 Anatomy of over-the-scope clips. A: Ovesco clip (Ovesco Endoscopy, Tubingen, Germany) is a bear-claw-shaped nitinol clip available in multiple cap sizes with three tooth profiles - type t (short spikes for compression/anchoring), type a (blunt, compressive), and type gc (elongated spiked teeth for robust gastric wall purchase)[32]; B: Padlock clip (STERIS Endoscopy, Ireland) is a hexagonal nitinol ring with six inward-facing prongs and tissue controllers that limit penetration depth and provide circumferential purchase. Citation for Figure 4A: OVESCO Endoscopy. OTSC^® System. [cited 30 October 2025]. Available from: https://ovesco.com/otsc-system/. It was obtained from the public manufacturer’s product page (Supplementary material).

Figure 5 Deployed over-the-scope clip. A: An Ovesco clip was used for hemostasis of a bleeding duodenal ulcer with pulsatile vessel; B: A Padlock clip was deployed to close a tracheoesophageal fistula after application of argon plasma coagulation on the edges[73]. Citation for Figure 5B: Rai P, Bhargava R. Successful closure of post-tracheostomy large chronic tracheoesophageal fistula with new over-the-scope clip. Dig Endosc 2017; 29: 634. Copyright© The Authors 2025. Published by Wiley. The author obtained permission from the publisher and was approved (Supplementary material).