Pilot study of metallic clip-assisted through-the-scope twin clip technique for defect closure after endoscopic full-thickness resection of small gastric subepithelial tumors.

Background: This pilot study aimed to evaluate the feasibility and efficacy of metallic clips assisted by through-the-scope twin clips (TTS-TC) for closing gastric wall defects following endoscopic full-thickness resection (EFR) for small gastric submucosal tumors (SMTs).

Methods: Nineteen patients with gastric SMTs originated from the muscularis propria were treated by EFR between May 2022 and July 2024. Twelve patients underwent endoscopic closure of the gastric wall defects after EFR with metallic clips and seven patients with TTS-TC and metallic clips.

Results: No significant differences existed between the two groups in terms of demographics, clinical characteristics, and the size of the gastric wall defects. The average time to close gastric wall defects was shorter in the TTS-TC group (6.3 ± 0.8 min) compared to the metallic clip group (9.9 ± 2.9 min). Closure costs were higher for the TTS-TC group than for the metallic clip group. The hospitalization time of the two groups had no statistical significance. No single case had surgical intervention or complications, such as gastric bleeding, perforation, peritonitis, or abdominal abscess. A follow-up EGD at the second month after surgery indicated that no postoperative complications occurred.

Conclusion: The metallic clips assisted with or without TTS-TC are safe and effective techniques for gastric defect closure after EFR for gastric SMTs. Because of the "kissing close," the TTS-TC more suitable for the lesions located at the gastric fundus, the greater curvature or anterior wall of the gastric body.