Endoscopic clip systems for hemostasis and defect closure in gastrointestinal endoscopy

Table 3 Steps in deployment of an over-the-scope clip

Steps	Ovesco clip (Ovesco Endoscopy)	Padlock (STERIS)
Set up the device	Attach hand wheel to biopsy port; inspect cap/clip and release thread	Attach external trigger/cable; inspect cap/clip; and confirm trigger function
Mount the cap on the endoscope and route actuation	Preload clip on transparent cap; route release thread through the working channel to hand wheel	Preload clip on cap; route actuation cable externally, leaving the working channel free
Prepare target site	Irrigate and adequately visualize the lesion	Same as Ovesco
Orient correctly	Center the lesion near the working-channel. Advance with cap over target; adjust torque or insufflation for a perpendicular approach	Same as Ovesco
Capture tissue	Use suction and/or Anchor or Twin Grasper; draw edges into cap	Use suction and grasping device via free channel to pull edges into cap more easily
Fire the clip	Rotate hand wheel to tension thread and deploy (similar to esophageal variceal band ligation mechanism)	Squeeze external trigger to deploy; no channel thread
Verify closure	Confirm apposition and hemostasis; irrigate or gently probe with a water jet	Same as Ovesco
Know when to escalate	If closure or hemostasis incomplete, add thermal/adjunct clips or place a second OTSC; consider suturing	Same as Ovesco

OTSC: Over-the-scope clip.