title: Which clip? A prospective comparative study of retention rates of endoscopic clips on normal mucosa and ulcers in a porcine model.
abstract: OBJECTIVE
  There are currently no data on the relative retention rates of the Instinct clip, Resolution clip, and QuickClip2Long. Also, it is unknown whether retention rate differs when clips are applied to ulcerated rather than normal mucosa. The aim of this study is to compare the retention rates of three commonly used endoscopic clips.
  
  
  METHODS
  Six pigs underwent upper endoscopy with placement of one of each of the three types of clips on normal mucosa in the gastric body. Three mucosal resections were also performed to create "ulcers." Each ulcer was closed with placement of one of the three different clips. Repeat endoscopy was performed weekly for up to 4 weeks.
  
  
  RESULTS
  Only the Instinct and Resolution clips remained attached for the duration of the study (4 weeks). At each time point, a greater proportion of Instinct clips were retained on normal mucosa, followed by Resolution clips. QuickClip2Long had the lowest retention rate on normal mucosa. Similar retention rates of Instinct clips and Resolution clips were seen on simulated ulcers, although both were superior to QuickClip2Long. However, the difference did not reach statistical significance. All QuickClip2Long clips were dislodged at 4 weeks in both the groups.
  
  
  CONCLUSIONS
  The Resolution and Instinct clips have comparable retention rates and both appeared to be better than the QuickClip2Long on normal mucosa-simulated ulcers; however this did not reach statistical significance. Both the Resolution clip and the Instinct clip may be preferred in clinical situations when long-term clip attachment is required, including marking of tumors for radiotherapy and anchoring feeding tubes or stents. Either of the currently available clips may be suitable for closure of iatrogenic mucosal defects without features of chronicity.
authors.forename: Payal
authors.initials: P
authors.lastname: Saxena
authors.forename: Eun
authors.initials: E
authors.lastname: Ji-Shin
authors.forename: Yamile
authors.initials: Y
authors.lastname: Haito-Chavez
authors.forename: Ali K
authors.initials: AK
authors.lastname: Valeshabad
authors.forename: Venkata
authors.initials: V
authors.lastname: Akshintala
authors.forename: Gerard
authors.initials: G
authors.lastname: Aguila
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.forename: Dawn S
authors.initials: DS
authors.lastname: Ruben
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Vikesh
authors.initials: V
authors.lastname: Singh
authors.forename: Marcia
authors.initials: M
authors.lastname: Canto
authors.forename: Anthony
authors.initials: A
authors.lastname: Kalloo
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D013276:Stomach Ulcer / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments; D013552:Swine