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Background <p>Secure closure after advanced endoscopic resection remains challenging, especially for large or full-thickness gastrointestinal (GI) defects. We developed a novel two-tooth clip (TTC) with enhanced anchoring capacity and evaluated its mechanical properties, tissue attachment, and clinical feasibility.</p> Methods <p>The TTC features inward-facing teeth for improved grip. Its performance was compared with conventional clips through tensile testing and finite element simulation. In vivo clip retention and histologic response were assessed in porcine models. Feasibility was further evaluated in pigs and clinical cases requiring mucosal defect closure.</p> Results <p>The TTC exhibited significantly greater pulling force than conventional clips (4.64 ± 0.11 N vs. 2.05 ± 0.09 N; <i>P</i> &lt; 0.05) and showed more distributed force transmission on simulation. In animal studies, TTCs demonstrated higher retention and good tissue compatibility. In clinical cases, technical and clinical success were achieved in 9 of 10 patients (90.0%), with complete closure of defects up to 6 × 3&#xa0;cm and no delayed perforation.</p> Conclusions <p>The TTC system is safe, effective, and compatible with standard endoscopic workflows. Its dual-tooth design offers enhanced closure strength and stability. Further comparative studies are needed to confirm its clinical value.</p> Graphical Abstract <p></p>

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A novel enhanced two-tooth clip for reliable defect closure endoscopically: An ex vivo comparative and in vivo feasibility study

  • 期刊论文

  • 发表日期：

    2025年12月12日

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  • Shuqian Hu,
  • Jindong Chu,
  • Yiyu Qiao,
  • Wei Shen,
  • Airong Tang,
  • Hanqing Zhang,
  • Xueting Zhang,
  • Min Min,
  • Yan Liu

摘要

Background

Secure closure after advanced endoscopic resection remains challenging, especially for large or full-thickness gastrointestinal (GI) defects. We developed a novel two-tooth clip (TTC) with enhanced anchoring capacity and evaluated its mechanical properties, tissue attachment, and clinical feasibility.

Methods

The TTC features inward-facing teeth for improved grip. Its performance was compared with conventional clips through tensile testing and finite element simulation. In vivo clip retention and histologic response were assessed in porcine models. Feasibility was further evaluated in pigs and clinical cases requiring mucosal defect closure.

Results

The TTC exhibited significantly greater pulling force than conventional clips (4.64 ± 0.11 N vs. 2.05 ± 0.09 N; P < 0.05) and showed more distributed force transmission on simulation. In animal studies, TTCs demonstrated higher retention and good tissue compatibility. In clinical cases, technical and clinical success were achieved in 9 of 10 patients (90.0%), with complete closure of defects up to 6 × 3 cm and no delayed perforation.

Conclusions

The TTC system is safe, effective, and compatible with standard endoscopic workflows. Its dual-tooth design offers enhanced closure strength and stability. Further comparative studies are needed to confirm its clinical value.

Graphical Abstract