Using a Novel Clip with Anchoring Prongs for Third-Space Endoscopy and Full-Thickness Defect Closure
Bibliographic record
Abstract
Aims This study evaluates the performance of a novel rotatable, anchor-pronged through-the-scope endoscopic clip (TTSC) in managing third-space endoscopy and full-thickness defect closure. Methods We conducted a multicenter, prospective cohort study of the anchor-pronged MANTIS clip (Boston Scientific Corporation, Marlborough, Massachusetts, USA) used at 10 sites in 6 countries (ClinicalTrials.gov number, NCT05653843). Cases involving prophylactic clipping after polypectomy, EMR, or ESD were excluded from the current analysis, which focused solely on more complex indications such as third-space procedures (submucosal myotomy, STER), and full-thickness resection or full-thickness defect closure. The outcomes were 1) complete defect closure without delayed bleeding at the original site, 2) rate of delayed bleeding requiring intervention within 30 days, and 3) incidence of device- or procedure-related serious adverse events (SAEs). Results Among 49 enrolled participants with 50 lesions, the mean age was 55.6±16.6 (range 23-80) years, and 24 (49.0%) were male. Indications for clipping included myotomy (n=21 lesions, 42.0%, including 11 per oral endoscopic myotomies [POEM], 7 gastric POEM [G-POEM], 1 Zenker POEM [Z-POEM], 2 bariatric endoscopic antral myotomies [BEAM]), bleeding (n=9, 18.0%), full-thickness resection (n=8, 16.0%), submucosal tunneling endoscopic resection (STER; n=6 lesions, 12.0%), endoscopic anti-reflux mucosectomy (ARMS; n=3, 6.0%), duodenal perforation closure or post-ERCP perforation prophylaxis (n=3, 6.0%). Complete defect closure was achieved in 49 (98.0%) lesions. No delayed bleeding occurred by 30 days after the index procedure. Three (6.0%) patients had 4 related SAEs, including colonic fistula bleeding in an ischemic colitis patient (1), submucosal leak in a POEM procedure (1), and septic shock and gastrointestinal mucosal injury associated with a G-POEM procedure (1). All related SAEs resolved by 10 days after onset. Conclusions The anchor-pronged TTSC demonstrated efficacy in third-space endoscopy and full-thickness defect closure, with high rates of successful defect closure and no delayed bleeding. The rate of SAEs further supports the clip's safety profile, making it a promising tool for managing third-space endoscopy and full-thickness defect closure. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".