Through-the-scope twin clip for closure of gastric endoscopic full-thickness resection defects: a retrospective...

Secure defect closure is critical in endoscopic full-thickness resection (EFTR). The through-the-scope twin clip (TTS-TC) is designed to overcome the shallow tissue grasping of titanium clips, facilitating deeper tissue apposition. This study evaluated the safety, clinical effectiveness, postoperative hospital stay, and hospitalization costs of the TTS-TC in gastric EFTR defect closure.

We retrospectively analyzed 121 patients with gastric lesions who underwent EFTR between June 2023 and June 2025. Patients were stratified into the TTS-TC group (n = 36) and the 10-mm titanium clip group (n = 85) based on the closure method. We compared procedure time, number of clips used, postoperative length of stay, incidence of intraoperative and postoperative adverse events, and hospitalization costs.

Both groups achieved definitive closure without major adverse events. Although the TTS-TC was preferred for larger and anatomically demanding lesions, subgroup analysis of defects >15 mm revealed that the TTS-TC group required significantly fewer clips and had a shorter median procedure time, with no statistically significant differences in postoperative length of stay or hospitalization costs. Multivariable regression analysis showed that the TTS-TC was independently associated with fewer clips used (p < 0.001), alongside a trend toward a shorter procedure time (p = 0.058).

In this retrospective observational comparison, the TTS-TC appears to be a safe and feasible option for closing gastric wall defects during EFTR, and demonstrates potential utility in managing selected large or anatomically challenging defects.