Endoscopic Clips (Endoclips): Appearance on X-ray and CT, with Reporting Tips
Endoscopic Clip — Hemoclip
🔍 How should this device be named?
An endoscopic clip is a small metallic device placed onto tissue within the gastrointestinal tract using an endoscope. It is also known as a hemoclip.
Purpose | What is it used for? | Suggested description when the purpose is confirmed |
Bleeding control | To achieve mechanical hemostasis in gastrointestinal bleeding caused by conditions such as peptic ulcers, Mallory–Weiss tears, or Dieulafoy lesions. | Endoscopic hemostatic clip (hemoclip) |
Defect closure after endoscopic resection | To close the defect following polypectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD); to reduce the risk of delayed bleeding in appropriately selected cases. | Endoscopic clip placed for post-resection defect closure |
Closure of an iatrogenic perforation | To endoscopically close gastrointestinal perforations of suitable size and location. | Endoscopic clip placed for perforation closure |
Endoscopic marking | To facilitate localization of a lesion or procedural site during subsequent assessment or intervention. | Endoscopic clip placed for marking |
Table 1. Clinical uses and examples of application [1–3].
Note: These descriptions indicate the purpose of use; they do not necessarily represent different device types. If the purpose of placement is unknown, the term “endoscopic clip” is sufficient in the radiology report.
How is it placed, and what does it do?
The type of clip illustrated here is passed through the working channel of the endoscope within a delivery catheter. Its metallic arms open when advanced beyond the tip of the endoscope. The target tissue is positioned between the arms; the arms are then closed to grasp the tissue, and the clip is deployed.
The closed clip remains attached to the tissue, while the delivery catheter is withdrawn. For bleeding control, the clip applies mechanical compression to the grasped tissue and vessel. Endoscopic clips are among the mechanical hemostatic devices used in gastrointestinal bleeding [1,2].
The device shown in this note is a through-the-scope (TTS) clip, which is passed through the working channel of the endoscope. Not all endoscopic clips share the same design; over-the-scope clips (OTSC), deployed from a cap mounted on the tip of the endoscope, are also available. The deployment mechanism described here applies to the TTS-type clip illustrated [5].
Endoscopic clips may detach from the tissue over time, enter the gastrointestinal lumen, and pass through the gastrointestinal tract. The time to detachment varies according to the clip type and application site; some clips may remain attached for months. Prolonged retention alone does not indicate delayed healing or a complication [4].
How do we identify it on imaging?
On plain radiographs: It appears as a small, distinctly radiopaque structure. The appearance of its body and arms varies with the clip design and projection.
On CT: It may appear as a dense metallic focus with surrounding streak artifact. Its relationship to the relevant gastrointestinal segment can be demonstrated more clearly than on radiographs.
Procedure history: A history of prior endoscopy supports device identification and clarification of its intended purpose.
Example case: An endoscopic clip in the stomach
Figure 5. On a consecutive axial CT image, the yellow arrow indicates the endoscopic clip, while the red arrows indicate gastric wall thickening in the same region.
In a patient with a history of gastrointestinal bleeding and a pathological diagnosis of mucinous gastric adenocarcinoma, the plain radiograph demonstrates a small radiopaque structure beneath the left hemidiaphragm, projecting over the proximal stomach.
On the axial CT image, the same structure appears as a metallic density in the proximal stomach with surrounding streak artifact. The findings are consistent with an endoscopic clip in the stomach. Although a history of bleeding is known, the precise purpose of clip placement and its relationship to the treated lesion cannot be confirmed without the endoscopy record.
📝 Example report wording
Plain radiograph:
“A small radiopaque structure consistent with an endoscopic clip is noted in the left upper quadrant, projecting over the proximal stomach.”
CT:
“An endoscopic clip is noted in the proximal stomach.”
If placement for bleeding control has been confirmed:
“An endoscopic hemostatic clip is noted in the proximal stomach.”
Reporting checklist
Checkpoint | Feature to assess |
Location | Projection on radiographs; relationship to the relevant gastrointestinal segment on CT |
Number | Number of visible clips |
Procedure history | Site, timing, and purpose of placement |
Previous examinations | Comparison of position with prior images |
Associated findings | Surrounding tissues and possible signs of complications, within the scope of the examination |
A brief note on MRI
The clip’s MRI safety status cannot be determined from its radiographic or CT appearance. The manufacturer and model, together with the manufacturer’s current MR conditions, should be checked. Some products are designated MR Conditional; this designation cannot be generalized to an unidentified clip [2].
Take-home point: Identify the device as an “endoscopic clip”; confirm its intended purpose from the procedure record.
References and image information
[1] Gralnek IM, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline — Update 2021. Endoscopy. 2021;53:300–332. doi:10.1055/a-1369-5274.
[2] Boston Scientific. Resolution™ Clip. Product information and manufacturer’s instructions for use.https://www.bostonscientific.com/en-EU/products/clips/resolution-clip.htmlAccessed: October 24, 2026.This source provides product-specific information; it does not identify the manufacturer/model of the clip in this case.
[3] Ferlitsch M, et al. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline — Update 2024. Endoscopy. 2024;56:516–545. doi:10.1055/a-2304-3219.
[4] Kim SH, et al. The risk factors for prolonged hemostatic clip retention after endoscopic submucosal dissection for gastric neoplasm.https://pubmed.ncbi.nlm.nih.gov/33629182/
[5] ASGE Technology Committee; Parsi MA, Schulman AR, Aslanian HR, et al. Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos). VideoGIE. 2019;4(7):285–299. doi:10.1016/j.vgie.2019.02.004.
Image source: ZKSK Medical. Disposable Endoscopic Flexible Hemoclip.
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