Secure closure of defects is essential after endoscopic full‑thickness resection (EFTR) of gastric lesions to prevent complications and promote recovery. Conventional 10‑mm titanium clips have limited tissue grasp depth, which can hinder secure approximation of thicker or high‑tension gastric wall defects. The through‑the‑scope twin clip (TTS‑TC) was developed to provide deeper tissue apposition and potentially improve closure efficiency for larger or anatomically demanding defects.
This retrospective comparative analysis aimed to evaluate the safety and clinical effectiveness of the TTS‑TC versus traditional 10‑mm titanium clips for closure of gastric EFTR defects, with prespecified comparisons of procedure time, number of clips used, postoperative length of stay, adverse events, and hospitalization costs.
Investigators retrospectively reviewed 121 patients who underwent gastric EFTR between June 2023 and June 2025. Patients were assigned to groups based on the closure technique used: the TTS‑TC group (n = 36) and the 10‑mm titanium clip group (n = 85).
Outcomes compared between groups included:
The authors also performed subgroup analyses for larger defects and multivariable regression to identify independent associations between closure method and outcomes of interest.
Both closure strategies achieved definitive closure of gastric EFTR defects without major adverse events reported in either group. The TTS‑TC was more frequently used for larger or anatomically demanding lesions per the authors’ case selection.
Key comparative findings reported in the abstract include:
Full numeric results for procedure times, clip counts in the overall cohort, adverse event rates stratified by type, and precise cost data were not provided in the abstract.
The authors performed a subgroup analysis limited to defects greater than 15 mm. Within this subgroup, they reported:
The abstract does not supply the subgroup sample sizes, absolute clip counts, or the specific median times and interquartile ranges; only the direction and statistical significance (where noted) are reported.
Multivariable regression was used to explore independent associations between the closure method and outcomes after adjusting for covariates. The analysis found that use of the TTS‑TC was independently associated with fewer clips used (p < 0.001). There was a statistical trend indicating a shorter procedure time with the TTS‑TC (p = 0.058), but this did not meet conventional thresholds for statistical significance in the reported analysis.
Details of the covariates included in the model, effect estimates, and confidence intervals were not presented in the abstract.
In this retrospective observational study of 121 gastric EFTR cases, the through‑the‑scope twin clip (TTS‑TC) was a safe and feasible option for defect closure. The device appeared particularly useful for selected larger or anatomically challenging defects, where it was associated with a reduced number of clips required and a trend toward reduced procedure time. Postoperative length of stay and hospitalization costs were similar between the TTS‑TC and conventional 10‑mm titanium clips in the reported analyses.
Clinicians should view these findings in the context of a retrospective design. The abstract does not report granular numerical data for many endpoints, nor does it provide detailed adverse event breakdowns or long‑term outcomes. Prospective or randomized comparisons would be required to confirm the observed associations and to define optimal selection criteria for the TTS‑TC.
The TTS‑TC is designed to achieve deeper tissue apposition than standard titanium clips, addressing the limitation of superficial grasping. In this study of 121 gastric EFTR procedures, the TTS‑TC closed defects safely and was independently associated with using fewer clips and showed a trend toward shorter procedure time, especially for larger or challenging defects. Length of stay and hospitalization costs were similar between the two closure approaches.
Note: The abstract provides summaries of the main comparisons and key p values but does not include full numerical tables or all model details in the source text provided.