Endoloop-assisted endoscopic removal of over-the-scope and full-thickness resection device clips: Prospective study

Background and study aims: The over-the-scope (OTS) clip system is an established tool for endoscopic management of gastrointestinal bleeding, perforations, fistulas, and, in its modified form as the full-thickness resection device (FTRD), for resection of gastrointestinal lesions. In selected cases, clip removal is required. Conventional techniques often demand costly devices and may be time-consuming. This study evaluated a novel, simple technique for endoscopic removal of OTS and FTRD clips using an endoloop, focusing on feasibility and safety. Patients and methods: This prospective single-center study included patients who had undergone OTS or FTRD clip placement and required clip removal between March 2021 and October 2024. The removal procedure involved positioning an endoloop underneath the clip. Follow-up endoscopy within 6 months assessed clip detachment. The primary endpoint was the success rate for clip removal; the secondary endpoint was incidence of adverse events (AEs). Results: A total of 18 patients underwent endoloop-assisted removal of OTS (50%, 9/18) or FTRD (50%, 9/18) clips. Endoloop placement was performed at a median of 94 days (range: 27-472) after OTS clip placement and 97 days (range: 0-274) after EFTR. Follow-up endoscopy confirmed clip detachment after a median of 107 days (range: 33-220) for OTS and 114 days (range: 5-203) for FTRD clips. Clip removal was successful in all patients (100%), with no AEs observed. Conclusions: Endoloop-assisted removal of OTS and FTRD clips appears to be effective and safe, representing an addition to current options for endoscopic clip removal.