A novel through-the-scope twin clip for the closure of gastrointestinal wounds: the first experimental survival study in pigs (with videos).

Background and Aims We developed a through-the-scope twin clip (TTS-TC) for closing gastrointestinal wounds. The objective of this study was to evaluate the efficacy and safety of the TTS-TC in gastrointestinal wound closure. Methods Gastrointestinal nonperforating and perforating wounds (≥2.5 cm) were created in live pigs. TTS-TCs were used to convert the large wounds into small wounds. The remaining small wounds were closed using conventional through-the-scope clips (TTSC). The follow-up period was 1 month. Location and size of the wound, time of wound closure, intraoperative and postoperative adverse events and the conditions of wound healing were investigated. Results Thirteen wounds were created in 5 live pigs, including 2 gastric nonperforating and 3 perforating wounds, and 5 large intestinal nonperforating and 3 perforating wounds. The average long and short diameters of the wounds was 4.1 (0.9) cm, 3.4 (0.7) cm, respectively. All wounds were successfully closed using the TTS-TCs combined with TTSCs. The total average time for wound closure was 9.2 (5.3) minutes, and the average time for using the TTS-TCs was 3.9 (4.7) minutes. During the 1-month follow-up period, no bleeding, perforation, or death occurred, all the wounds healed with scar formation, and all the TTS-TCs detached spontaneously. Conclusions The TTS-TC was successfully used to close large-sized gastrointestinal wounds. The TTS-TC is a promising tool for large-size wound closure under flexible endoscopy.