Anendoclip, also referred to as ahemostatic clip or ahemoclip,^[1][2] is a metallic mechanical device used inendoscopy in order to close two mucosal surfaces without the need for surgery andsuturing. Its function is similar to asuture in gross surgical applications, as it is used to join together two disjointed surfaces, but, can be applied through the channel of an endoscope under direct visualization. Endoclips have found use in treatinggastrointestinal bleeding (both in theupper andlower GI tract), in preventing bleeding after therapeutic procedures such aspolypectomy, and in closinggastrointestinal perforations. Many forms of endoclips exist of different shapes and sizes, including two and three prong devices, which can be administered using single use and reloadable systems, and may or may not open and close to facilitate placement.

The endoclip was first described by Hayashi and Kudoh in 1975,^[3] and was termed the "staunch clip". Initial attempts to incorporate the clip into applications inendoscopy (such as clipping bleedingblood vessels) were limited by the applicator system of the clip.^[3] However, by 1988, an easy to use applicator delivery system was developed, and a functional reloadable endoclip system was described.^[4] This consisted of a stainless steel clip (of size approximately 6 mm long and 1.2 mm wide at the prongs) with a metal deployment device (that could be used to insert the clip into the endoscopic camera, and deployed outside the camera) enclosed in a plastic sheath.^[3] These clips were initially reloadable.^{[citation needed]}

Endoclips in use today have a variety of additional shapes and sizes than the original. Clips with two and three prongs (TriClip,Cook Medical^[5]) have been described and used for various applications.^[6] Rotatable clips have been devised to improve localization of deployment.^[7] Also, clips that open and close (as opposed to single-deployment) have also been developed (Resolution Clip,Boston Scientific^[8]), and also facilitate the appropriate location of deployment.^[9]

When a treatablelesion is identified onendoscopy (such as a bleeding vessel), an endoclip can be inserted through the channel of the endoscope until the sheathed clip is visible on the endoscopic image, and the handle for deployment handed to thenurse assistant. The clip is unsheathed by retraction at the handle, positioned, and "fired" by the assistant to treat the lesion.^{[citation needed]}

Endoclips have found a primary application inhemostasis (or the stopping of bleeding) duringendoscopy of the upper (throughgastroscopy) or lower (throughcolonoscopy)gastrointestinal tract.^[3] Many bleeding lesions have been successfully clipped, including bleedingpeptic ulcers,^[6]Mallory-Weiss tears of theesophagus,^[10]Dieulafoy's lesions,^[11]stomach tumours,^[12] and bleeding afterremoval of polyps.^[13] Bleedingpeptic ulcers require endoscopic treatment if they show evidence of high risk stigmata of re-bleeding, such as evidence of active bleeding or oozing onendoscopy or the presence of a visible blood vessel around the ulcer.^[14][15] The alternatives to endoscopic clipping of peptic ulcers are thermal therapy (such aselectrocautery to burn the vessel causing the bleeding), or injection ofepinephrine to constrict the blood vessel. Comparative studies between endoclips and thermal therapy make the point that endoclips cause less trauma to themucosa around the ulcer than electrocautery,^[16] but no definitive advantage to either approach has reached consensus bygastroenterologists.^[17][18]

Endoclips have also found an application in preventing bleeding when performing complicated endoscopic procedures. For example, prophylactic clipping of the base of apolyp has been found to be useful in preventing post-polypectomy bleeding, especially in high-risk patients or patients onanticoagulant medications.^[19] In addition, clips can be used to closegastrointestinal perforations that may have been caused by complicated therapeutic endoscopy procedures, such aspolypectomy, or by the endoscopic procedure itself.^[20] Clips have also been used to secure the placement of endoscopicfeeding tubes,^[21] and to orient thebile duct to assist withendoscopic retrograde cholangiopancreatography, a procedure used to image to bile duct.^[22]

Endoclips have been seen to dislodge between 1 and 3 weeks from deployment,^[23] although lengthy clip retention intervals of as high as 26 months have been reported.^[3][11] Endoclips are believed to be safe and no major complications (such as perforation or impaction) have been reported with them, although concern has been raised about blocking the outflow of the bile duct if clips are deployed in theduodenum.^[3]

• Gastroenterology
• Implants (medicine)
• Endoscopy

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