Choosing the right through-the-scope clip: a rigorous comparison of rotatability, whip, open/close precision, and closure strength (with videos)

Background and Aims: Many new through-the-scope clips are available, and physicians often select clips based on physical characteristics and/or cost. However, functional profiles may be equally important and have not been methodically assessed. We evaluated 5 commercially available clips: Resolution 360, Instinct, Quick Clip Pro, Dura Clip, and SureClip. Methods: We rigorously compared clips on multiple characteristics, including rotatability, overshoot, open/close precision, and tensile/closure strength. Clips were tested in 4 different endoscope configurations: (1) straight, (2) duodenal sweep, (3) full retroflexion, and (4) across the duodenoscope elevator. Results: For rotatability, the Resolution 360 was the fastest due to its unique functionality in allowing primary MD control in rotation (P<.05). The Resolution 360, SureClip, and Dura Clip were able to rotate through the prescribed sequence across all scope configurations. For overshoot, the SureClip and Resolution 360 had the least overshoot for the straight configuration at 0%. All clips had >75% overshoot at more strained configurations. For open/close precision, the SureClip and Dura Clip showed precise opening/ closing with the ability to stop at any point. The remaining clips exhibited abrupt opening with more controlled closure. For tensile strength, the Quick Clip Pro generated the highest peak force as would be required in lateral tissue manipulation (4.8 lb, P<.005). For closure strength, the Instinct overall showed the most gel compression, and along with the Resolution 360, showed 100% deployment success for all gel tissue thicknesses (up to 10 mm). Conclusions: Each clip has a unique physical and functional profile, which may be a factor in selection depending on the clinical circumstance.