Endoscopic clipping devices are instruments designed to achieve tissue approximation
during gastrointestinal endoscopy. Although endoscopic clips were initially developed for
the primary purposes of accomplishing hemostasis of focal gastrointestinal bleeding, the
indications for endoscopic clipping have expanded to include closure of perforations and
fistulas, securing positioning of catheters and stents as well as to provide a
radio-opaque markers to direct endoscopic, radiological, and surgical therapy.
Traditionally, through-the-scope (TTS) clipping devices consist of 2 main components:
metallic double pronged clips and delivery/deployment catheter-handle assembly. TTS clips
are the most used devices for both hemostasis and defect closure given the familiarity
and ease of use. However, larger defects or those in a difficult position within the GI
tract can be difficult to close using conventional TTS clips alone, given the inherent
restrictions in clip opening width and inability to approximate large gaps firmly and
securely. Incomplete closure can have serious consequences, including delayed bleeding
and need for additional interventions including surgery for treatment of acute
perforations.
The Dual Action Tissue (DAT) clip is a novel, Federal Drug and Administration (FDA)
approved commercially available 3-arm TTS clip designed for endoscopic closure of large
defects. Compared to conventional TTS clips, the DAT clip has an additional center post
or fixed column in the middle position. The two arms of the DAT clip operate independent
of each other, with an overall maximum opening width angle of 60 degrees. Opening and
closing of each arm is controlled by two color-coded handles, which facilitates
distinguishment of the clip arms during operation. The arm on one side of the DAT clip is
opened to clamp the edge of a defect. The clamped mucosa can then be pulled close to the
other side of the defect. The second arm of the DAT is then opened to clamp the opposite
edge. Once both edges of the defect are secured by the arms of the DAT clip, the clip can
then be deployed by firmly pressing and releasing both handles simultaneously.
Experimental studies using the DAT clip have confirmed its safety and efficacy and shown
it to be easy to operate, safe and effective for defect closure. Our initial experience
in 6 cases (unpublished data) supports its safety and its utility as an additional
endoscopic tool in our armamentarium for challenging tissue approximation. However, more
data is needed to evaluate the performance and the role of the DAT clip. The purpose of
this study is to prospectively evaluate our experience with the DAT clip as part of
routine medical care.