Endoscopic Clips: Past, Present and Future

A form of the metal clip (also known as a ‘hemoclip’ or ‘endoclip’) for flexible endoscopes has now been available for more than 15 years (1), with early versions presented more than 30 years ago (2). Although uptake was initially slow, clips have made their way into standard gastrointestinal endoscopic practice for common indications, such as ulcer (3), Mallory-Weiss tear (4,5), diverticular bleeding (6,7), or bleeding or high-risk (8–10) polypectomy sites. They are also increasingly being used for uncommon indications, such as securing stents (11,12), feeding tubes (13) and other devices; marking of endoscopic lesions for x-ray or magnets (14,15); closing fistulas as presented in the article by Hameed et al (16) in this month’s Journal ( pages 217–219); and perforations (17), including sealing the luminal entry site in experimental natural orifice transluminal endoscopic surgery (NOTES) (18). The indication with the highest level of evidence at the present time is clearly ulcer hemostasis (3), but animal models and case series of other indications are rapidly accumulating. Dr Joseph Romagnuolo is an associate professor at the Medical University of South Carolina, Charleston, South Carolina, USA