Role of clips, devices and sprays in endoscopic hemostasis: An update (with videos).

Clips, devices and sprays are important tools in the armamentarium of interventional endoscopists which are needed to tackle challenging clinical scenarios. There has been a revolutionary change in the design and features of modern-day endoscopic clips that has greatly increased its applicability. Both through-the-scope clip (TTS clip) and over-the-scope clips (OTSC) have their role in day-to-day clinical practice with each having some advantages and disadvantages. Sprays have been an important adjunct to clips which can be extremely useful in difficult clinical scenarios where clips may not work. There has been growing evidence with regard to its use in literature. Many different types of TTS clips are available that have combination of different properties such as size, tail length, rotatability, re-openability and tensile strength. Two types of OTSC are available which differs according to their design and mechanism of application. Though TTS clips are still most used clips in day-to-day practice, we recommend that OTSCs should be used as a primary modality in patients who are at high risk of rebleeding such as patients on dual anti-platelets, those requiring to restart anticoagulation early, patients with chronic kidney disease and in large (> 1.5 cm) fibrotic ulcer bleeds. Herein, we describe technical and clinical aspects, types, applications and optimal usage techniques of different clips, devices and sprays commonly used in endoscopy.