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A novel through-the-scope twin clip (TTS-TC) was developed for the closure of large gastrointestinal tract wounds [1, 2]. In the current study, we initially explored the application of TTS-TC traction-assisted endoscopic submucosal dissection (ESD) in an in vitro pig stomach model. TTS-TC traction-assisted gastric ESD was performed as follows (▶Video 1). (i) First, the mucosa was marked at the greater curvature of the stomach, and submucosal injection was performed, followed by mucosal incision along the marked points (▶Fig. 1 a). (ii) A TTS-TC was delivered through the endoscopic working channel (3.2-mm inner diameter) into the stomach cavity (▶Fig. 1 b), and the clip on one side of the TTS-TC was opened by controlling the handle to clamp the oral side of the incised mucosa (fixed point 1) (▶Fig. 1 c). (iii) The other side of the TTS-TC was opened to clamp the mucosa of the anterior wall of the lesser curvature of the stomach on the opposite side of the incised mucosa (fixed point 2) (▶Fig. 1d). (iv) The submucosa was fully exposed through the mutual traction between the two fixed points (▶Fig. 1 e), and an endoscopic knife was then used to dissect the submucosa. Only one TTS-TC was used to complete the mucosal traction. The size of the dissected mucosa was 3.8×2.5 cm. The total operation time was 19.6 minutes, with the time taken to dissect the submucosa being 8 minutes. The TTS-TC did not detach from the two fixed sites during dissection of the submucosa. The wound was completely closed with one TTS-TC and three conventional throughthe-scope clips (TTSCs), with the time taken for wound closure being 4 minutes. The TTS-TC is a promising device for mucosal traction to assist gastric ESD.

A novel through-the-scope twin clip traction-assisted endoscopic submucosal dissection in an in vitro pig stomach model