To the Editor, We read with great interest the study by Daram et al. which provided benchtop data on inherent mechanical strengths during closure and after deployment and the rotational abilities of three types of through-the-scope (TTS) clips: QuickClip2 long (Olympus America, Center Valley, PA, USA), Resolution clip (Boston Scientific, Natick, MA, USA), and instinct clip (Cook Medical, Winston-Salem, NC, USA). Device-in-endoscope retro-flection angles, opening strength, snapping force of acute clip closure, and neoprene pulling strength of each clip were measured across various configurations of a gastro-scope, duodenoscope, and colonoscope (H180AL/I; Olympus America). The authors tested the rotational capabilities of the three clips on 15 different configurations of the endoscopes. Two components were measured: the number of turns on the clip device handle required to achieve a meaningful rotation and the lag time for an endoclip to demonstrate meaningful rotation after rotation on the device handle. They found that the instinct and QuickClip2 clips could be rotated clockwise or counterclockwise 1.67-13.67 turns and 1-5.33 turns, respectively. Lag times varied between 1.31 and 16.99 s and between 0.5 and 5.63 s, respectively, among the 15 configurations of the three endoscopes. They were able to rotate the Resolution clip in a colonoscope only in the straight position with a 17.97 s delay after 19.67 turns.
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