title: Utility of a new reusable clip device for endoscopic treatment.
abstract: OBJECTIVE
  Existing reusable endoscopic clip devices have some problems regarding opening the device and precise control of clip application. The aim of the present study was to evaluate reusable clip devices for endoscopic treatment.
  
  
  METHODS
  Ability to close a large defect and grip force were evaluated using ex-vivo porcine colon. We assessed clip loading and opening in a non-clinical setting and describe the resulting learning curve. To evaluate clinical utility, data for clip application in 72 post-endoscopic mucosal resection (EMR) defects in 40 patients were retrospectively analyzed.
  
  
  RESULTS
  There was no difference in the ability to close a 20-mm full-thickness defect and the grip force comparing the new clip device (ZEOCLIP®) and a previously used reusable clip device (EZClip®). Although the time to load the ZEOCLIP was almost same as the EZClip, the time to open the ZEOCLIP was significantly shorter than the EZClip (P < 0.001). Opening width of the ZEOCLIP was significantly wider than the EZClip (P < 0.05). We successfully accomplished closure of post-EMR defects by clip application in 72 lesions using ZEOCLIP. Reopening/repositioning and restoring it to the working channel were more frequently carried out in a non-easy location than in an easy location (11/35 [31%] vs 4/37 [11%], P = 0.030; and 21/35 [60%] vs 1/37 [3%], P < 0.001, respectively).
  
  
  CONCLUSIONS
  ZEOCLIP is more quickly and easily opened to its maximum width compared with EZClip, and is feasible for clip application after EMR.
authors.affiliation: Shinozaki Medical Clinic, Tochigi, Japan; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shinozaki
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.forename: Toshiya
authors.initials: T
authors.lastname: Otake
authors.forename: Alan T
authors.initials: AT
authors.lastname: Lefor
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D000818:Animals; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D004867:Equipment Design; D017743:Equipment Reuse / Q000592:standards; D005260:Female; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000601:surgery*; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000706:statistics & numerical data*; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine
keywords: clip application; endoscopic mucosal resection (EMR); endoscopic treatment; polypectomy; reusable clip device