---
title: "Through-the-scope twin clip (TTS‑TC) vs titanium clips for gastric EFTR defect closure"
id: "pubmed-42768943"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42768943"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42768943/"
doi: "10.1080/07853890.2026.2735108"
published_at: "2026-09-22T10:14:15.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Through-the-scope twin clip (TTS‑TC) vs titanium clips for gastric EFTR defect closure
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42768943
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42768943/)
- **DOI:** [10.1080/07853890.2026.2735108](https://doi.org/10.1080%2F07853890.2026.2735108)
- **Published At:** 2026-09-22T10:14:15.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective comparative study assessed closure of gastric endoscopic full‑thickness resection (**EFTR**) defects using a novel **through‑the‑scope twin clip (TTS‑TC)** versus conventional 10‑mm titanium clips. - The cohort comprised 121 patients who underwent gastric EFTR between June 2023 and June 2025; 36 patients received TTS‑TC closure and 85 received 10‑mm titanium clip closure. - Primary comparisons included procedure time, number of clips used, postoperative length of stay, intraoperative and postoperative adverse events, and hospitalization costs. - Both closure approaches achieved definitive defect closure with no major adverse events reported in either group. - The TTS‑TC was preferentially used for larger or anatomically demanding lesions according to the authors’ practice patterns. - In a subgroup analysis of defects larger than 15 mm, the **TTS‑TC group required significantly fewer clips** and had a **shorter median procedure time** compared with the titanium clip group; postoperative length of stay and hospitalization costs did not differ significantly. - Multivariable regression identified use of the **TTS‑TC** as independently associated with **fewer clips used** (p < 0.001) and showed a trend toward **shorter procedure time** (p = 0.058). - The authors conclude that the **TTS‑TC** appears to be a safe and feasible option for gastric wall defect closure after EFTR, with potential advantages for selected large or high‑tension defects. - Plain‑language summary reiterates that the TTS‑TC is designed for deeper tissue apposition to overcome superficial grasping of standard titanium clips and may offer procedural benefits in complex closures. - The report is a retrospective observational analysis; specific numerical values for subgroup sizes beyond the stated cohort counts and detailed adverse event listings were not reported in the abstract.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 22. # Through-the-scope twin clip for closure of gastric endoscopic full-thickness resection defects: a retrospective comparative study [Wenhui Xia](https://pubmed.ncbi.nlm.nih.gov/?term=Xia+W&cauthor_id=42768943)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#full-view-affiliation-1 "The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China."), [Yuxuan Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+Y&cauthor_id=42768943)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#full-view-affiliation-1 "The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China."), [Qianqian Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+Q&cauthor_id=42768943)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#full-view-affiliation-2 "Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China."), [Xiuyu Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+X&cauthor_id=42768943)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#full-view-affiliation-1 "The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China."), [Jianyu Lv](https://pubmed.ncbi.nlm.nih.gov/?term=Lv+J&cauthor_id=42768943)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#full-view-affiliation-1 "The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China."), [Shuo Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+S&cauthor_id=42768943)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#full-view-affiliation-2 "Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#full-view-affiliation-3 "Key Laboratory of Traditional Chinese Medicine for the Treatment of Intestine-Liver of Zhejiang Province, Hangzhou, China.") Affiliations Expand ### Affiliations * 1 The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China. * 2 Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China. * 3 Key Laboratory of Traditional Chinese Medicine for the Treatment of Intestine-Liver of Zhejiang Province, Hangzhou, China. * PMID: **42768943** * DOI: [ 10.1080/07853890.2026.2735108 ](https://doi.org/10.1080/07853890.2026.2735108) Item in Clipboard Comparative Study # Through-the-scope twin clip for closure of gastric endoscopic full-thickness resection defects: a retrospective comparative study Wenhui Xia et al. Ann Med. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Ann Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ann+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42768943/) . 2026 Dec;58(1):2735108. doi: 10.1080/07853890.2026.2735108. Epub 2026 Sep 22. ### Authors [Wenhui Xia](https://pubmed.ncbi.nlm.nih.gov/?term=Xia+W&cauthor_id=42768943)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#short-view-affiliation-1 "The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China."), [Yuxuan Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+Y&cauthor_id=42768943)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#short-view-affiliation-1 "The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China."), [Qianqian Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+Q&cauthor_id=42768943)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#short-view-affiliation-2 "Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China."), [Xiuyu Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+X&cauthor_id=42768943)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#short-view-affiliation-1 "The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China."), [Jianyu Lv](https://pubmed.ncbi.nlm.nih.gov/?term=Lv+J&cauthor_id=42768943)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#short-view-affiliation-1 "The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China."), [Shuo Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+S&cauthor_id=42768943)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#short-view-affiliation-2 "Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42768943/#short-view-affiliation-3 "Key Laboratory of Traditional Chinese Medicine for the Treatment of Intestine-Liver of Zhejiang Province, Hangzhou, China.") ### Affiliations * 1 The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China. * 2 Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China. * 3 Key Laboratory of Traditional Chinese Medicine for the Treatment of Intestine-Liver of Zhejiang Province, Hangzhou, China. * PMID: **42768943** * DOI: [ 10.1080/07853890.2026.2735108 ](https://doi.org/10.1080/07853890.2026.2735108) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Secure defect closure is critical in endoscopic full-thickness resection (EFTR). The through-the-scope twin clip (TTS-TC) is designed to overcome the shallow tissue grasping of titanium clips, facilitating deeper tissue apposition. This study evaluated the safety, clinical effectiveness, postoperative hospital stay, and hospitalization costs of the TTS-TC in gastric EFTR defect closure. **Methods:** We retrospectively analyzed 121 patients with gastric lesions who underwent EFTR between June 2023 and June 2025. Patients were stratified into the TTS-TC group (_n_ = 36) and the 10-mm titanium clip group (_n_ = 85) based on the closure method. We compared procedure time, number of clips used, postoperative length of stay, incidence of intraoperative and postoperative adverse events, and hospitalization costs. **Results:** Both groups achieved definitive closure without major adverse events. Although the TTS-TC was preferred for larger and anatomically demanding lesions, subgroup analysis of defects >15 mm revealed that the TTS-TC group required significantly fewer clips and had a shorter median procedure time, with no statistically significant differences in postoperative length of stay or hospitalization costs. Multivariable regression analysis showed that the TTS-TC was independently associated with fewer clips used (_p_ < 0.001), alongside a trend toward a shorter procedure time (_p_ = 0.058). **Conclusions:** In this retrospective observational comparison, the TTS-TC appears to be a safe and feasible option for closing gastric wall defects during EFTR, and demonstrates potential utility in managing selected large or anatomically challenging defects. **Keywords:** Endoscopic full-thickness resection; defect closure; endoscopy; gastric lesions; through-the-scope twin clip; titanium clip. ## Plain language summary The TTS-TC is theoretically designed to facilitate deeper tissue apposition, helping to overcome the limitations of superficial grasping inherent in traditional titanium clips.The TTS-TC was independently associated with fewer clips used, alongside a marginal trend toward shorter procedure time.The TTS-TC may offer procedural advantages in managing larger, challenging, or high-tension gastric defects, providing a practical alternative for complex closure. 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