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A novel through-the-scope twin endoclip (TTS-TC) has been developed by our team. The TTS-TC can be delivered directly through an endoscope working channel of 3.2mm in diameter and contributes to the closure of large mucosal wounds. A living pig (Feed Research Institute, Guangzhou City, China) weighing 30.5 kg was used to conduct the experiment in vivo. A QF-260 J gastroscope (Olympus, Tokyo, Japan) was used. TTS-TC was used to reduce the size of the mucosal wound after endoscopic submucosal dissection (ESD) (▶Video 1). The operation steps were as follows. First, the TTS-TC was delivered to the site of the ESD wound through the endoscope working channel (▶Fig. 1 a). The clip on one side of TTS-TC was opened by operating the handle of the TTS-TC system, followed by tight clamping of mucosal tissue on one side of the wound (▶Fig. 1b). Then, the clamped tissue was pulled toward the opposite side of the wound (▶Fig. 1 c), and the second clip on the TTS-TC was opened to clamp the mucosal tissue on this side of wound (▶Fig. 1d). After the two sides of the wound had been clamped together, the TTS-TC was released and the wound was closed (▶Fig. 1 e). Using this TTS-TC technique, the large wound on the anterior wall of the greater curvature of the stomach was successfully turned into two smaller wounds. After using a TTSTC, the wound size decreased, and TTSTC or traditional through-the-scope clips (TTSC) could subsequently be used to close the wound conveniently. The size of the wound in the current case was 3.4×3.3 cm. The currently available through-the-scope clips can only close a wound of < 2 cm [1], and the over-thescope-clip requires installation on the outside of the endoscope tip and sometimes the endoscope may need to be reinserted [2, 3]. The TTS-TC device seems to be simple and rapid in operation, and can be used to close a large mucosal wound. E-Videos

A novel through-the-scope twin endoclip for a large mucosal closure in a live pig model