Endo clips

Endo clips, also known as, endoscopic clips, endoclips or haemoclips are therapeutic accessories used to halt gastrointestinal bleeding ¹ during endoscopy procedures. The quantity of clips used is dependent on the extent of perforated tissue resulting in bleeding occurring.

These endoscopic clips often detach spontaneously between 9 days ² and 2 weeks ³ after deployment, although there have been studies showing their retention for several years ^2,3.

Radiographic features

Plain radiograph

The clip is visible as a linear density on abdominal x-rays.

CT

The clip may cause beam hardening artefact on CT abdominal imaging.

MRI

Obtaining the brand and model of these clips is important as the American College of Radiology expert panel on MRI safe practices recommends that identifying medical implants and their MRI compatibility must be made before MRI.

The 2017 AJR article by Accorsi et al. ⁴ provides MRI safety information on some common endoscopic clip models:

• Boston Scientific Resolution Clip (MRI conditional)

• Cook Medical Tri-Clip (MRI unsafe)

• Ethicon Endo-Surgery Clip (MRI conditional)

• Olympus Medical Systems QuickClip, EZ Clip and Long-Clip (MRI unsafe)

MRI of the abdomen is often discouraged for patients with the presence of endoscopic clips due to the possibility of:

1. clip deflection/migration ^{4, 8}

2. magnetic susceptibility artefact: visible on MR abdominal scans, may obscure anatomy of interest

3. heating: leading to soft tissue burns

History and etymology

First introduced in 1975 by Hayashi et al. ⁵, the endo clip was popularized when Nib Soehendra ⁶ (1942-current), a German endoscopic surgeon, and colleagues made use of the clip for hemostasis ⁷.