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Endoclip therapy in the gastrointestinal tract: Bleeding lesions and beyond

Jonathan Cohen, MD
Irphan Gaslightwala, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF


In 1975, two Japanese groups developed a method by which to deploy a hemostatic metal clip through a flexible endoscope for the purpose of hemostasis [1,2]. The early clips were cumbersome and difficult to use, complicated by frequent misfire rates and technical difficulties in positioning the clip during endoscopy. However, their use spread rapidly through Japan initially and then in Europe. More recently endoscopic clipping technology has also gained greater acceptance in the United States.

Endoscopic clips are used widely not only for the treatment of gastrointestinal bleeding but also for a variety of other gastrointestinal problems. In this review, we will describe the various clips currently available along with basic principles of clip application. The practical aspects of particular applications and the evidence supporting their role will also be presented.


The most recent iterations of endoclips are a marked improvement over earlier models. They are available in multiple sizes and some can be rotated or reopened while being deployed through the endoscope [3]. Four companies produce disposable endoclips for use in the United States market.

Olympus USA, Corp. produces the QuickClip2, which is a rotatable clip device (picture 1). These devices are produced in two sizes, 8 mm or 12 mm in width when opened and 165 cm to 230 cm in length, allowing deployment through a colonoscope.

Boston Scientific, Inc. produces the Resolution Clip, which cannot be rotated but can be reopened after closure if repositioning is required (picture 2). The Resolution Clip has an opening width of 11 mm and is available in lengths of 165 cm and 235 cm.

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Literature review current through: Nov 2017. | This topic last updated: Feb 03, 2017.
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  1. Hayashi T, Yonezawa M, Kawabara T. The study on staunch clip for the treatment by endoscopy. Gastroenterol Endosc 1975; 17:92.
  2. Kuramata H. Evaluation of gastrofiberscope for treatment (TGF proto-type by Olympus Co). Stomach Intestine 1974; 9:355.
  3. Daram SR, Tang SJ, Wu R, To SD. Benchtop testing and comparisons among three types of through-the-scope endoscopic clipping devices. Surg Endosc 2013; 27:1521.
  4. Chan CY, Yau KK, Siu WT, et al. Endoscopic hemostasis by using the TriClip for peptic ulcer hemorrhage: a pilot study. Gastrointest Endosc 2008; 67:35.
  5. Lin HJ, Hsieh YH, Tseng GY, et al. A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding. Am J Gastroenterol 2002; 97:2250.
  6. Jensen DM, Machicado GA, Hirabayashi K. Hemoclipping (CLIP) of chronic ulcers: A randomized prospective study of initial success, CLIP retention rates, and ulcer healing. Gastrointest Endosc 2005; 61:AB174.
  7. Jensen DM, Machicado GA, Hirabayashi K. Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers. Gastrointest Endosc 2006; 64:768.
  8. Shin EJ, Ko CW, Magno P, et al. Comparative study of endoscopic clips: duration of attachment at the site of clip application. Gastrointest Endosc 2007; 66:757.
  9. Sung JJ, Tsoi KK, Lai LH, et al. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 2007; 56:1364.
  10. Cipolletta L, Bianco MA, Marmo R, et al. Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc 2001; 53:147.
  11. Chou YC, Hsu PI, Lai KH, et al. A prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers. Gastrointest Endosc 2003; 57:324.
  12. Chung IK, Ham JS, Kim HS, et al. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc 1999; 49:13.
  13. Gevers AM, De Goede E, Simoens M, et al. A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc 2002; 55:466.
  14. Ljubicic N. Efficacy of endoscopic clipping and long-term follow-up of bleeding Dieulafoy's lesions in the upper gastrointestinal tract. Hepatogastroenterology 2006; 53:224.
  15. Shimoda R, Iwakiri R, Sakata H, et al. Evaluation of endoscopic hemostasis with metallic hemoclips for bleeding gastric ulcer: comparison with endoscopic injection of absolute ethanol in a prospective, randomized study. Am J Gastroenterol 2003; 98:2198.
  16. Lin LF, Siauw CP, Ho KS, Tung JC. Endoscopic hemoclip treatment of gastrointestinal bleeding. Chang Gung Med J 2001; 24:307.
  17. Saltzman JR, Strate LL, Di Sena V, et al. Prospective trial of endoscopic clips versus combination therapy in upper GI bleeding (PROTECCT--UGI bleeding). Am J Gastroenterol 2005; 100:1503.
  18. Lin HJ, Lo WC, Cheng YC, Perng CL. Endoscopic hemoclip versus triclip placement in patients with high-risk peptic ulcer bleeding. Am J Gastroenterol 2007; 102:539.
  19. Yuan Y, Wang C, Hunt RH. Endoscopic clipping for acute nonvariceal upper-GI bleeding: a meta-analysis and critical appraisal of randomized controlled trials. Gastrointest Endosc 2008; 68:339.
  20. Yamaguchi Y, Yamato T, Katsumi N, et al. Endoscopic hemoclipping for upper GI bleeding due to Mallory-Weiss syndrome. Gastrointest Endosc 2001; 53:427.
  21. Huang SP, Wang HP, Lee YC, et al. Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding. Gastrointest Endosc 2002; 55:842.
  22. Chung IK, Kim EJ, Lee MS, et al. Bleeding Dieulafoy's lesions and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods. Gastrointest Endosc 2000; 52:721.
  23. Park CH, Sohn YH, Lee WS, et al. The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions. Endoscopy 2003; 35:388.
  24. Hokama A, Uehara T, Nakayoshi T, et al. Utility of endoscopic hemoclipping for colonic diverticular bleeding. Am J Gastroenterol 1997; 92:543.
  25. Rino Y, Imada T, Iwasaki H, et al. Hemostasis of colonic diverticular bleeding with hemoclips under endoscopic control: report of a case. Hepatogastroenterology 1999; 46:1733.
  26. Simpson PW, Nguyen MH, Lim JK, Soetikno RM. Use of endoclips in the treatment of massive colonic diverticular bleeding. Gastrointest Endosc 2004; 59:433.
  27. Binmoeller KF, Thonke F, Soehendra N. Endoscopic hemoclip treatment for gastrointestinal bleeding. Endoscopy 1993; 25:167.
  28. Parra-Blanco A, Kaminaga N, Kojima T, et al. Hemoclipping for postpolypectomy and postbiopsy colonic bleeding. Gastrointest Endosc 2000; 51:37.
  29. Sobrino-Faya M, Martínez S, Gómez Balado M, et al. Clips for the prevention and treatment of postpolypectomy bleeding (hemoclips in polypectomy). Rev Esp Enferm Dig 2002; 94:457.
  30. Liaquat H, Rohn E, Rex DK. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 2013; 77:401.
  31. Albéniz E, Fraile M, Ibáñez B, et al. A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions. Clin Gastroenterol Hepatol 2016; 14:1140.
  32. Zhang QS, Han B, Xu JH, et al. Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest Endosc 2015; 82:904.
  33. Qumseya BJ, Wolfsen C, Wang Y, et al. Factors associated with increased bleeding post-endoscopic mucosal resection. J Dig Dis 2013; 14:140.
  34. Shimamoto C, Hirata I, Umegaki E, Katsu K. Closure of an esophageal perforation due to fish bone ingestion by endoscopic clip application. Gastrointest Endosc 2000; 51:736.
  35. Raymer GS, Sadana A, Campbell DB, Rowe WA. Endoscopic clip application as an adjunct to closure of mature esophageal perforation with fistulae. Clin Gastroenterol Hepatol 2003; 1:44.
  36. Shimizu Y, Kato M, Yamamoto J, et al. Endoscopic clip application for closure of esophageal perforations caused by EMR. Gastrointest Endosc 2004; 60:636.
  37. Tsunada S, Ogata S, Ohyama T, et al. Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips. Gastrointest Endosc 2003; 57:948.
  38. Yoshikane H, Hidano H, Sakakibara A, et al. Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc 1997; 46:464.
  39. Minami S, Gotoda T, Ono H, et al. Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 2006; 63:596.
  40. Baron TH, Gostout CJ, Herman L. Hemoclip repair of a sphincterotomy-induced duodenal perforation. Gastrointest Endosc 2000; 52:566.
  41. Katsinelos P, Paroutoglou G, Papaziogas B, et al. Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips. World J Gastroenterol 2005; 11:6232.
  42. Charabaty-Pishvaian A, Al-Kawas F. Endoscopic treatment of duodenal perforation using a clipping device: case report and review of the literature. South Med J 2004; 97:190.
  43. Heldwein W, Dollhopf M, Rösch T, et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 2005; 37:1116.
  44. Mana F, De Vogelaere K, Urban D. Iatrogenic perforation of the colon during diagnostic colonoscopy: endoscopic treatment with clips. Gastrointest Endosc 2001; 54:258.
  45. Taku K, Sano Y, Fu KI, Saito Y. Iatrogenic perforation at therapeutic colonoscopy: should the endoscopist attempt closure using endoclips or transfer immediately to surgery? Endoscopy 2006; 38:428.
  46. Merrifield BF, Lautz D, Thompson CC. Endoscopic repair of gastric leaks after Roux-en-Y gastric bypass: a less invasive approach. Gastrointest Endosc 2006; 63:710.
  47. Frizzell E, Darwin P. Endoscopic placement of jejunal feeding tubes by using the Resolution clip: report of 2 cases. Gastrointest Endosc 2006; 64:454.
  48. Baron TH, Song LM, Ross A, et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc 2012; 76:202.
  49. Manta R, Galloro G, Mangiavillano B, et al. Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc 2013; 27:3162.
  50. ASGE Technology Committee, Wong Kee Song LM, Banerjee S, et al. Emerging technologies for endoscopic hemostasis. Gastrointest Endosc 2012; 75:933.
  51. Kirschniak A, Subotova N, Zieker D, et al. The Over-The-Scope Clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 2011; 25:2901.
  52. Voermans RP, Le Moine O, von Renteln D, et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10:603.
  53. Cho SB, Lee WS, Joo YE, et al. Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc 2012; 26:473.