Surgical Endoscopy

, Volume 27, Issue 5, pp 1521–1529 | Cite as

Benchtop testing and comparisons among three types of through-the-scope endoscopic clipping devices

  • Sumanth R. Daram
  • Shou-Jiang TangEmail author
  • Ruonan Wu
  • S. D. Filip To



Through-the-scope (TTS) endoscopic clipping devices are widely used. No benchtop testing or direct comparisons of these endoclips have been performed to show their rotational ability and inherent mechanical strengths during closure and after deployment. This study aimed to provide benchtop data that can be used to guide clinical applications and to promote future device research and development.


Benchtop testing and comparisons were performed for three groups of TTS clips: QuickClip2 long, resolution, and instinct clips. The main outcome measurements were device-in-endoscope retroflection angles (DIERA), opening strength, “snapping” force of acute clip closure, and neoprene pulling strength.


The achievable gastroscope DIERA was 10° for QuickClip2, 3° for the resolution clip, and 10° for the instinct clip. The QuickClip and the Instinct clip rotated almost equally well under all endoscope configurations, including endoscopic retrograde cholangiopancreatography (ERCP). With or without a sheath, the resolution clip lacked the ability to rotate. During clip opening force testing (the amount of force required to force open the jaws of a deployed clip by 3.2 mm; 3.2 mm was chosen due to the standard dimension of the gauge used for the measurement), the Instinct clips were the strongest. For the Instinct clips, an opening force of 404 ± 124 g was needed to open the closed clip, and an additional 386 ± 133 g was required to open the clip jaws to 3.2 mm. In terms of snapping force during acute closure and neoprene pulling strength, the instinct and resolution clips performed almost equally. The limitations of the study were the benchtop testing and the finite sample size for closing and pulling strength comparisons.


The QuickClip2 and the Instinct clip rotate equally well under different endoscope configurations. The resolution clips lack rotational ability. The instinct clips are stronger mechanically than the other two TTS clips. Stronger clips are perhaps associated with higher therapeutic efficacy and retention rates.


Benchtop testing Clip Clipping device Device-in-endoscope retroflection angle Endoclip Endoscope Endoscopy Opening strength Rotation 





Endoscopic retrograde cholangiopancreatography


Device-in-endoscope retroflection angles


Research and development


Magnetic resonance imaging


Standard deviation



Some of the endoclips used in this study were provided by Cook Medical, Winston-Salem, NC, USA.


Sumanth R. Daram, Shou-jiang Tang, Ruonan Wu, and S. D. Filip To have no conflicts of interest or financial ties to disclose.


  1. 1.
    Hayashi T, Yonezawa M, Kawabara T (1975) The study on staunch clip for the treatment by endoscopy. Gastroenterol Endosc 17:92–101Google Scholar
  2. 2.
    Raju GS, Gajula L (2004) Endoclips for GI endoscopy. Gastroenterol Endosc 59:267–279CrossRefGoogle Scholar
  3. 3.
    Raju GS, Kaltenbach T, Soetikno R (2007) Endoscopic mechanical hemostasis of GI arterial bleeding (review with videos). Gastrointest Endosc 66:774–785PubMedCrossRefGoogle Scholar
  4. 4.
    Technology Assessment Committee, Chuttani R, Barkun A, Carpenter S, Chotiprasidhi P, Ginsberg GG, Hussain N, Liu J, Silverman W, Taitelbaum G, Petersen B (2006) Endoscopic clip application devices. Gastrointest Endosc 63:746–750PubMedCrossRefGoogle Scholar
  5. 5.
    Technology Committee ASGE, Conway JD, Adler DG, Diehl DL, Farraye FA, Kantsevoy SV, Kaul V, Kethu SR, Kwon RS, Mamula P, Rodriguez SA, Tierney WM (2009) Endoscopic hemostatic devices (review). Gastrointest Endosc 69:987–996CrossRefGoogle Scholar
  6. 6.
    Kopelman Y, Siersema PD, Bapaye A, Kopelman D (2012) Endoscopic full-thickness GI wall resection: current status. Gastrointest Endosc 75:165–173PubMedCrossRefGoogle Scholar
  7. 7.
    Gill KR, Pooley RA, Wallace MB (2009) Magnetic resonance imaging compatibility of endoclips. Gastrointest Endosc 70:532–536PubMedCrossRefGoogle Scholar
  8. 8.
    McCurry JB, Tang SJ, Marks C, Dave B (xxxx) Successful management of a gastric arteriovenous malformation with endoclip application and angioembolization. (submitted)Google Scholar
  9. 9.
    Jensen DM, Machicado GA, Hirabayashi K (2006) Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers. Gastrointest Endosc 64:768–773PubMedCrossRefGoogle Scholar
  10. 10.
    Maiss J, Dumser C, Zopf Y, Naegel A, Krauss N, Hochberger J, Matthes K, Hahn EG, Schwab D (2006) Hemodynamic efficacy of two endoscopic clip devices used in the treatment of bleeding vessels, tested in an experimental setting using the compact erlangen active simulator for interventional endoscopy (compact EASIE) training model. Endoscopy 38:575–580PubMedCrossRefGoogle Scholar
  11. 11.
    Shin C, Ko P, Magno S et al (2007) Comparative study of endoscopic clips: duration of attachment at the site of clip application. Gastrointest Endosc 66:757–761PubMedCrossRefGoogle Scholar
  12. 12.
    Kato M, Jung Y, Gromski MA, Chuttani R, Matthes K (2012) Prospective, randomized comparison of 3 different hemoclips for the treatment of acute upper GI hemorrhage in an established experimental setting. Gastrointest Endosc 75:3–10PubMedCrossRefGoogle Scholar
  13. 13.
    Ooka K, Shibuya M, Suzuki Y (1997) A comparative study of intracranial aneurysm clips: closing and opening forces and physical endurance. Neurosurgery 40:318–323PubMedCrossRefGoogle Scholar
  14. 14.
    Nagatani T, Shibuya M, Ooka K, Suzuki Y, Takayasu M, Yoshida J (1998) Titanium aneurysm clips: mechanical characteristics and clinical trial. Neurol Med Chir Tokyo 38(Suppl):39–44PubMedCrossRefGoogle Scholar
  15. 15.
    Papadopoulos MC, Apok V, Mitchell FT, Turner DP, Gooding A, Norris J (2004) Endurance of aneurysm clips: mechanical endurance of Yaşargil and Spetzler titanium aneurysm clips. Neurosurgery 54:966–970PubMedCrossRefGoogle Scholar
  16. 16.
    Hsu TC (2006) Comparison of holding power of metal and absorbable hemostatic clips. Am J Surg 191:68–71PubMedCrossRefGoogle Scholar
  17. 17.
    Hepworth CC, Kadirkamanathan SS, Gong F, Swain CP (1998) A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels. Gut 42:462–469PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Sumanth R. Daram
    • 1
  • Shou-Jiang Tang
    • 1
    Email author
  • Ruonan Wu
    • 1
  • S. D. Filip To
    • 2
  1. 1.Division of Digestive Diseases, Department of MedicineUniversity of Mississippi Medical CenterJacksonUSA
  2. 2.Department of Agricultural and Biological EngineeringMississippi State UniversityStarkvilleUSA

Personalised recommendations