Procedure Workflow: Unlike through-the-scope clips, applying an over-the-scope clip (OTSC) requires withdrawing the scope, attaching the cap-mounted clip to the distal tip, and re-entering the organ lumen to deploy the clip [00:35 Opens in a new window ].

Type A Clip: Features blunted, rounded teeth and is used for hemostasis [01:34 Opens in a new window ].
Type T (Therapeutic) Clip: Features small spikes to grip tissue and close perforations throughout the gastrointestinal tract [01:58 Opens in a new window ].
GC Clip: Features longer spikes for use in the stomach to close non-healing gastrostomy (PEG site) fistulas [02:21 Opens in a new window ].

Hand Wheel & Thread Retriever: Mount the hand wheel onto the scope's biopsy port [04:24 Opens in a new window ]. Push the thread retriever through the biopsy channel until it exits the distal tip [04:34 Opens in a new window ].
Cap Placement: Hook the clip's thread to the retriever, pull it back through the biopsy channel, and wrap it around the hand wheel [04:44 Opens in a new window ].
Alignment: Push the OTSC cap completely flush against the scope tip without leaving gaps [05:06 Opens in a new window ]. Rotate the cap so the thread aligns directly with the biopsy channel to avoid obstructing the optical view [05:59 Opens in a new window ].

Insertion Challenge: Adding the OTSC cap makes the scope tip significantly larger and stiffer, complicating passage through the upper esophageal sphincter [07:12 Opens in a new window ].
Patient Positioning & Relaxation: Maintain the neck and airway in a straight line using a jaw thrust [07:46 Opens in a new window ]. For intubated patients, muscle paralyzing agents can relax sphincter tone for smoother insertion [08:06 Opens in a new window ].

Suction Method: For non-scarred tissue or bleeding vessels, apply suction to draw tissue into the cap before rotating the hand wheel to deploy [10:05 Opens in a new window ].
Tissue Grasper (Anchor): Uses sharp spiked tips to hold and draw scarred tissue into the cap when suction is insufficient [10:49 Opens in a new window ].
Twin Grasper: Uses independently operated left and right jaws to capture opposite edges of larger defects or perforations [11:52 Opens in a new window ].
Safety Warning: Always pull any ancillary grasper deep inside the cap before deploying the clip to prevent clipping the tool itself [11:18 Opens in a new window ].
Potential Risks: Avoid unintentional capture or closure of adjacent anatomical structures such as the pylorus, duodenum, or ureters [15:07 Opens in a new window ].