Endoscopic removal of the Padlock-G clip
Bibliographic record
Abstract
In recent years various new endoscopic closure techniques and devices have been developed [ 1 ]. Research has mainly been driven by the need for a secure and reliable closure for natural orifice transluminal endoscopic surgery (NOTES) [ 2 ]. At present, the clinical applicability of NOTES remains unclear, but research in this area has already immeasurably enriched our endoscopic armamentarium with regards to endoscopic closure of perforations [ 1 ] [ 3 ] [ 4 ]. Recently, two novel clipping devices have been developed, which are conceptually similar to endoscopic band ligation [ 3 ] [ 4 ] [ 5 ]. One of these devices is the Padlock-G clip ([ Fig. 1 ]; Aponos Medical, Kingston, New Hampshire, USA), the feasibility of which has been demonstrated recently [ 5 ]. Fig. 1 Padlock-G clip closure device. a The clip; b the loaded clip on the applicator cap. The closure mechanism consists of a 16.5-mm nitinol clip delivered via an over-the-scope delivery pod. Herein we report a technique that we have developed for the safe removal of this clip after it has been deployed. In a 34-kg female domestic pig under general anesthesia, an 18-mm gastric wall opening was created using a needle knife and a dilation balloon. The Padlock-G clip was deployed after approximating the gastrotomy borders with a specialized tissue approximation grasper (Ovesco Endoscopy AG, Tübingen, Germany), thus creating a full-thickness closure of the defect ([ Fig. 2 a ], [ Video 1 ]). Time to achieve endoscopic closure was 3 minutes. Fig. 2 Removal of the Padlock-G clip. a The Padlock-G clip closure of an 18-mm full-thickness gastric wall defect. b – d Padlock-G clip removal using a standard endoscopic snare. By grasping two of the side bars ( b ), each anchoring pin of the clip can be pulled out of the tissue ( c ) in a serial fashion and the clip is removed ( d ). Quality: mobile 360 480 720 Download Video 1 Padlock closure of an 18-mm gastric wall defect. For removal, a soft oval endoscopic snare (SD-210U-25, Olympus, Center Valley, Pennsylvania, USA) was used. By grasping two of the side bars, each anchoring pin of the clip can be pulled out of the tissue in a serial fashion and the clip can be removed with minimal tissue trauma ([ Fig. 2 b – d ], [ Video 2 ]). Removal was facilitated within 1 minute and without complications. Quality: mobile 360 480 720 Download Video 2 Technique of endoscopic Padlock removal. In conclusion, the novel Padlock-G clip seems to be a promising new device for endoscopic organ wall closure with the additional benefit of easy and swift endoscopic removal in cases of unsatisfactory or incomplete closure attempts. Competing interests: None Endoscopy_UCTN_Code_TTT_1AO_2AI
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".