A novel clip with mantis-like claws combined with the over-the-scope clip for fistula closure

A novel clip with mantis-like claws combined with the over-the-scope clip for fistula closure Fig. 1 Over-the-scope (OTS) clip application.a The Twin Grasper system (Ovesco Corp., Tbingen, Germany) grasps both sides of the peristomal tissue and is retracted into the hood.b When the OTS clip is released with insufficient retraction, it may accidentally bite into the Twin Grasper system, making the removal of the device difficult.c, d If the OTS clip accidentally bites the MANTIS Clip, the device can be removed by releasing the MANTIS Clip. Fig. 2 Features of the MANTIS Clip (Boston Scientific Japan, Tokyo, Japan).a MANTIS Clips have a 60claw angle and are excellent at maintaining tissue grip.b, c MANTIS Clips are easy to rotate.