The procedure was performed by various endoscopists including non-experts; however, all cases were performed under expert supervision to ensure quality of practice. In those undergoing HSE-C, once the source of active bleeding is identified, between 0.5 mL and 2.0 mL of HSE solution is injected into the submucosa around the neck of the responsible diverticulum, a process which is repeated 1–4 times (Figure 2 ). Injections are generally repeated until the bleeding is weakened enough to gain an improved visual field, so that clipping can be performed in a stable environment. HSE-C injection was abbreviated in the monotherapy group. The clipping method administered was either a direct method, where a clip is placed directly into the diverticulum and onto the bleeding vessel, or an indirect method, where the opening of the bleeding diverticulum is indirectly closed off via a zipper method (Figure 3 ). Direct clipping is generally the method of choice, with indirect clipping only performed when visibility is insufficient or if the maneuverability of the scope is poor. Colonoscopy was performed using one of the following scopes (PCF-Q260AZI, PCF-H290ZI, PCF-H290I, CF-HQ290I, Olympus Medical Systems, Tokyo, Japan), fitted with a transparent hood, and EZ clips (Olympus Medical Systems) were used for clipping.
Ez clip
Manufactured by Olympus
Sourced in Japan
The EZ Clip is a versatile lab equipment product designed for secure and efficient sample handling. It provides a simple and effective solution for clipping and holding various types of samples during laboratory procedures. The core function of the EZ Clip is to securely grip and position samples, enabling researchers to maintain control and organization during their work.
Automatically generated - may contain errors
Lab products found in correlation
Kd 640l, by Olympus (3 mentions)
Vio300d, by Erbe (2 mentions)
Esg 100, by Olympus (2 mentions)
Snaremaster, by Olympus (2 mentions)
Gif q260j, by Olympus (2 mentions)
Cf hq290i, by Olympus (1 mentions)
Pcf h290i, by Olympus (1 mentions)
Pcf h290zi, by Olympus (1 mentions)
Pcf q260azi, by Olympus (1 mentions)
Triangle tip knife, by Olympus (1 mentions)
Gif h180j, by Olympus (1 mentions)
Cf q260al, by Olympus (1 mentions)
Gif 1th190, by Olympus (1 mentions)
Coagrasper g, by Olympus (1 mentions)
Dh 28gr, by Fujifilm (1 mentions)
Pcf h180al, by Olympus (1 mentions)
25g endoscopic needle injector, by Boston Scientific (1 mentions)
Dualknife, by Olympus (1 mentions)
Gif h290t, by Olympus (1 mentions)
Captivator 2, by Boston Scientific (1 mentions)
24 protocols using ez clip
1
Hemostatic Endoscopic Submucosal Injection and Clipping for Diverticular Bleeding
2
Peroral Endoscopic Myotomy Technique
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POEM procedure is performed according to the technique described by Inoue et al [10] in 2010. Broad spectrum antibiotics (usually a cephalosporin or amoxicillin) are administered preoperatively. An upper endoscopy is performed using a high-definition endoscope (GIF-H180J; Olympus Tokyo, Japan) with carbon dioxide (CO 2 ) insufflation. The esophageal mucosa is cut on the anterior wall using an endoscopic cautery knife (Triangle-tip knife, Olympus), approximately 10-12 cm above the esophageal gastric junction (Fig. 1A). After the mucosal incision is completed, the esophageal submucosa is dissected using a spray coagulation current (VIO300D, ERBE Elektromedizin GmbH, Tubingen, Germany) (Fig. 1B). A long tunnel is created in the esophageal submucosa extending from the mucosal incision to 3 cm along the anterior gastric wall (Fig. 1C). The esophageal muscular layer is exposed and cut through the submucosal tunnel. The myotomy includes the circular bundles of the muscular layer and extends for 2-3cm up the gastric wall (Fig. 1D). At the end of the procedure, the mucosal incision is closed using endoscopic clips (EZ Clips, Olympus). Twenty-four or 48 hours after myotomy, an upper endoscopy under general anesthesia and a gastrografin esophageal study are performed to exclude mucosal tears or leaks; then patients are fed a soft diet.
3
Colonoscopic Polypectomy with Hemoclip Placement
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Polypectomies were carried out with a standard colonoscope (Olympus CF Q260AL Tokyo, Japan) and snare (SD-11 U-1; loop diameter, 25 mm; Olympus, Tokyo, Japan). Before snare polypectomies, an adequate volume of normal saline solution was injected into the submucosa beneath the sessile polyps through an injection needle. The polyp was resected by snare with electrosurgical current using an ESG-100 (Olympus, Tokyo, Japan) with cutting and coagulation settings ranging between 20 W and 40 W. After the polypectomy procedure, hemoclips (EZClip, Olympus, Tokyo, Japan) were prophylactically placed according to decision of the polypectomy-performed endoscopist. The endoscopic images of prophylactic hemoclip placement were shown in supplementary figure . In patients with major bleeding after polypectomy, various hemostatic procedures including hemoclipping were performed and these patients were excluded from this study. Carbon dioxide was used throughout the polypectomy procedures in all patients.
4
Endoscopic Therapeutic Procedures
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Therapeutic channel (3.7 mm) endoscope (GIF-1TH190; Olympus, Tokyo, Japan), tapered transparent cap (DH-28GR; Fujifilm, Tokyo, Japan), bipolar device (Speedboat-RS2; Creo Medical Ltd, Chepstow, Wales, UK), endoscopic clips (EZ Clip, HX-610 – 090L; Olympus Corp.), and coagulation forceps (Coagrasper G, FD-412LR, Olympus, Japan) were used.
5
Endoscopic Submucosal Dissection in Pediatric Colonoscopy
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UESD, UESD-R (DiLumen, Lumendi, LLC) or traditional cap-assisted ESD method (Olympus cap D-201-12704) were performed using a pediatric colonoscope (Olympus PCF-H180AL). Monopolar electrosurgery was performed using ERBE electrosurgical generator with Olympus Dualknife (KD-650U) and IT nano (KD-612U), 80w Cut 40w Coagulation. Submucosal injection was used in all cases (0.04 % methylene blue, normal saline solution) through a Boston Scientific 25G endoscopic needle injector. Clips – Olympus EZ clip – Long clip.
6
Clipping Technique for Prophylactic Closure of Mucosal Break
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Since mid‐2014, the clipping method using an ECD was adopted for prophylactic closure of the mucosal break and it was performed for all cases from November 2015. After resection of the papilla, clipping was first performed at the anal end to prevent expansion of the mucosal break. Next, as many clips as possible were used for clipping toward the oral side taking care to avoid overlapping of the clips and avoid closing of the orifice of the pancreatic duct by the clip at the oral end. Normal mucosa from two opposite sides was grabbed using the tips of the clips to tightly close the mucosal break. Between June 2014 and September 2018, the EZ Clip (Olympus Medical Systems) was used as a conventional clip (Figure 1 ); however, we used the SureClip® (Micro‐Tech Co. Ltd.) since April 2019 (Figure 2 ; Supporting Information Video 1 ).
7
Peroral Endoscopic Myotomy for Achalasia
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POEM was performed by Dr. YH Youn and Dr. HS Chung as described by Inoue et al. [15 (link)] in patients under general anesthesia and CO2 insufflation. First, saline supplemented with indigo carmine was injected into the submucosal space on the anterior or posterior wall of the mid-esophagus. Subsequently, a 2-cm longitudinal mucosal incision was made as a mucosal entry into the submucosal space using a triangle-tip knife (KD-640L; Olympus, Tokyo, Japan). Second, the submucosal layer was dissected to create a tunnel along the esophagus and across the EGJ 2 or 3 cm into the proximal stomach. Third, the myotomy was started 2–3 cm below the tunnel entry and extended 2 or 3 cm into the cardia. Lastly, the mucosal entry site was closed with endoscopic clips (EZ-CLIP; Olympus). After POEM, patients received intravenous antibiotics and nutrition for 1–3 days, after which they began to take liquid food that gradually changed to solid food. Patients were followed up with Eckardt scores, HRM, and barium esophagogram 2 months after POEM.
8
Endoscopic Resection for Rectal NETs
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Endoscopic resection for rectal NETs sized up to 10 mm was usually performed during the initial colonoscopy by the attending staff of the colorectal unit. Abdominal CT was performed after resection because the risk for metastasis for these tumors is very low. Because endoscopic ultrasound is not available in our unit, we selected the endoscopic resection technique according to the tumor size and endoscopic morphology (Fig. 1 ).
For EMR, after submucosal saline injection (NeedleMaster injection needle, Olympus Corp., Tokyo, Japan), a 10-mm snare (SnareMaster, Olympus Corp.) was used for resection. Finally, we performed endoscopic clipping (EZ clip, Olympus Corp.) in all cases.
For P-EMR, we performed a circumferential incision to the submucosa around the lesion using an endoscopic knife (Dual Knife, Olympus Corp.) before snare resection.
ESD was primarily performed using the Dual Knife. We used glycerol for submucosal lifting. A transparent distal cap was used from the start of ESD to provide countertraction for dissection.
For EMR, after submucosal saline injection (NeedleMaster injection needle, Olympus Corp., Tokyo, Japan), a 10-mm snare (SnareMaster, Olympus Corp.) was used for resection. Finally, we performed endoscopic clipping (EZ clip, Olympus Corp.) in all cases.
For P-EMR, we performed a circumferential incision to the submucosa around the lesion using an endoscopic knife (Dual Knife, Olympus Corp.) before snare resection.
ESD was primarily performed using the Dual Knife. We used glycerol for submucosal lifting. A transparent distal cap was used from the start of ESD to provide countertraction for dissection.
9
Endoclip Detachment Force Measurement
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To determine how much force is required to detach the endoclips, one Olympus EZ clip was attached to the stomach and another to the small intestine. The clips were connected to a spring balance using dental floss (Fig. 3 ). The QuickClip Pro clip was not included in this part of the experiment since this type of endoclip has been shown to be compatible with MRI. With the porcine tissue placed in a transparent plastic container, the spring balance was gently pulled, in a direction perpendicular to the mucosal surface until the endoclip was detached. The magnitude of force required to detach the clip was measured immediately when the clip separated from the mucosa. The experiment was repeated twice. Measurements were obtained for endoclips placed normally and for those pushed further into the tissue, mimicking deeper attachment.![]()
Application of the endoclip and assessment of the endoclip detachment force with a spring balance. The endoclip was placed on the surface of the mucosa and attached to a spring balance with dental floss. The spring balance was gently pulled, perpendicular to the endoclip placement, until the clip was completely detached.
10
Endoscopic Mucosal Resection Techniques
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For EMR and UEMR, midazolam was used for sedation, and butylscopolamine or glucagon was used to suppress peristalsis. A gastroscope with a water‐jet function (GIF‐Q260J or GIF‐H290T; Olympus Medical Systems) was used. For lesions located in the distal duodenum that could not be reached using gastroscopy, a colonoscope (CF‐H290TI; Olympus) was used. A transparent hood (TOP Corporation) was attached to the tip of the endoscope. Depending on the lesion size, a 10 or 15 mm electro‐surgical snare (Captivator II; Boston Scientific, or SnareMaster; Olympus) was chosen. For cEMR, 0.4% sodium hyaluronate (Muco Up; Boston Scientific) diluted twice with a 10% glycerin solution containing a small amount of indigo carmine was used for submucosal injection. For UEMR, the lumen was filled with saline using a water jet after air deflation. After the resection, the mucosal defect was completely closed using an EZ clip (Olympus).
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