Repositionable over-the-scope clip

Abstract

To provide a clipping system for an endoscope.SOLUTION: The system includes an adapter 108 configured to be mounted on an insertion device, and a clip 102 including a first jaw and a second jaw movable between an insertion configuration and an initial deployment configuration. The first extension member is releasably coupled to the clip and movably connected to the adapter to allow movement of the clip relative to the adapter from the insertion configuration to the initial deployment configuration. The first extension member is configured to place the system in a review configuration to allow the adapter to be pulled away from the clip to improve visual observation of the clip. The first extension member is operable to retract the clip over the adaptor such that the clip is forced open, releasing the clip from the tissue being clipped. The first extension member is configured to release the clip therefrom in the final deployed configuration.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] FIELD OF THE DISCLOSURE The present disclosure relates to endoscopic devices, and more particularly to endoscopic clipping devices for treating tissue. [Background technology]

[0002] Physicians are becoming more willing to perform aggressive interventional and therapeutic endoscopic gastrointestinal (GI) procedures, which may increase the risk of perforating the wall of the GI tract or may require closure of the GI tract wall as part of the procedure. Such procedures may include, for example, removal of large lesions, tunneling under the mucosal layer of the GI tract to treat submucosal lesions, full-thickness removal of tissue, treatment of lesions on other organs by passing outside the GI tract, and endoscopic treatment / repair of post-surgical lesions (e.g., post-surgical leaks, surgical staple line injuries, and anastomotic leaks).

[0003] Currently, tissue can be treated through endoscopic closure devices, including through-the-scope clips and over-the-scope clips. Over-the-scope clips can be particularly useful for achieving closure of larger tissue defects. These endoscopic closure devices can save hospitals money and provide benefits to patients. However, in some cases, current endoscopic closure devices can be difficult to use, time-consuming to deploy, or inadequate for certain perforations, conditions, and anatomical structures. For example, current over-the-scope clips generally require the operator to deliver the clip from a position where the operator cannot visualize the clip itself. That is, prior to clipping, the operator visualizes the target tissue to be clipped and, based on this visualization of the target tissue, can determine that the distal end of the device and the clip are in the desired position relative to the target tissue. Then, based on observation of the target tissue, the operator deploys the clip without being able to see the clip itself until it is deployed. Once deployed, such current over-the-scope clips generally cannot be repositioned. Summary of the Invention

[0004] The present embodiment is directed to a clipping system for treating tissue, the clipping system including: an adapter configured to mount onto a distal end of an insertion device and extending longitudinally from a proximal end to a distal end; and a clip including a first jaw and a second jaw, wherein a first end of the first jaw is connected to a first end of a second jaw via a first hinge and a second end of the first jaw is connected to a second end of the second jaw via a second hinge, such that the first jaw and the second jaw are movable between an insertion configuration and an initial deployed configuration, wherein in the insertion configuration, the clip is mounted on the adapter such that the first jaw and the second jaw are spaced apart from each other to receive tissue therebetween, and in the initial deployed configuration, the first jaw and the second jaw are drawn toward each other to grasp tissue therebetween, and at least one of the first hinge and the second hinge is biased to pull the clip toward the initial deployed configuration. The first extension member is releasably coupled to the clip and movably connected to the adapter, enabling movement of the clip relative to the adapter from an insertion configuration to an initial deployed configuration. The first extension member is configured to allow the adapter to be pulled proximally away from the clip while the extension member remains coupled to the clip, placing the system in a review configuration in which the clip is physically separated from the adapter for improved visual observation of the clip. The first extension member is operable to retract the clip proximally on the adapter, whereby retracting the clip on the adapter forces the clip open, releasing the clip from the clipped tissue. When the clip is observed to be clipped in the desired position, the first extension member is also configured to release the clip therefrom in a final deployed configuration.

[0005] In one embodiment, the system may further include a second extension member releasably coupled to the clip and movably connected to the adapter, the second extension member configured to remain coupled to the clip while the clip is moved toward the initial deployment configuration and while the system is moved to the review configuration, the second extension member operable in cooperation with the first extension member to proximally retract the clip on the adapter from one of the review configuration and the initial deployment configuration and to release the clip therefrom in the final deployment configuration.

[0006] In one embodiment, the proximal end of the first elongated member and the proximal end of the second elongated member may be connected to one another and to a control element that extends proximally therefrom to a proximal end accessible to a user of the system.

[0007] In one embodiment, the distal portion of the adapter to which the clip can be attached in the insertion configuration may be tapered toward the distal end of the adapter such that reducing tension along the first extension member causes the clip to slide distally along the distal portion of the adapter from the open configuration toward the initial deployment configuration.

[0008] In one embodiment, the distal portion of the adapter may include a flat portion along its outer surface and a protrusion extending radially inward from an inner surface of the distal portion of the adapter, the flat portion for reducing friction between the clip and the adapter when the clip is moved distally along the flat portion from the open configuration toward the initial deployed configuration, and the protrusion configured to engage a portion of the clip when the clip is moved from the initial deployed configuration toward the open configuration.

[0009] In one embodiment, the distal end of each of the first and second elongated members may include a loop configured to hook onto a portion of a corresponding one of the first and second hinges, and the distal end of each of the first and second elongated members is biased radially away from the longitudinal axis of the adapter, such that when the loop of the first and second elongated members hook onto the first and second hinges, respectively, the distal ends of the first and second elongated members are constrained toward an engaged configuration, and when the distal ends of the first and second elongated members disengage from the first and second hinges, the distal ends of the first and second elongated members spring laterally outward to release the clip therefrom in the final deployed configuration.

[0010] In one embodiment, the first jaw may include an opening extending therethrough for engaging the first elongate member. In one embodiment, the first elongated member can include an expansion member releasably connected to a distal end of the first elongated member, the first elongated member being releasably coupled to the opening of the first jaw via the expansion member.

[0011] In one embodiment, the clip may be movable from the review configuration to the final deployed configuration by pressing the expansion member proximally against the first jaw and pulling the first extension member proximally relative to the adapter until the force exerted thereon exceeds a predetermined threshold such that the expansion member disengages from the distal end of the first extension member.

[0012] In one embodiment, the system may further include a strand connected to and extending proximally from the expansion member, such that the clip is movable from the review configuration to the final deployed configuration by pulling the strand proximally until the expansion member disengages from the distal end of the first extension member.

[0013] In one embodiment, the first elongate member may include a coil extending from a proximal end to a distal end and a wire extending from the distal end of the coil and looped through an opening in the first jaw, the distal end of the wire being releasably attached to the distal end of the coil such that the first jaw is releasably coupled to the clip via the wire.

[0014] In one embodiment, the first elongate member can include a proximal portion and a distal portion connected to one another via a releasable connection, with the distal portion connected to the clip via an opening extending through the first jaw.

[0015] In one embodiment, the releasable connection may include a retaining element including a first end fixedly attached to a proximal portion of the first elongated member and a second end releasably attached to a distal portion of the first elongated member, such that when the retaining element is moved distally beyond the distal end of the channel of the adapter, the distal portion of the first elongated member is released therefrom.

[0016] The present embodiment is directed to a clipping system for treating tissue, the clipping system including: an endoscope including a shaft extending longitudinally from a proximal end to a distal end; and an adapter including a proximal portion mounted on the distal end of the endoscope shaft and a distal portion extending distally from the proximal portion, the distal portion tapering toward the distal end. A clip is configured to be mounted on the distal portion of the adapter, the clip including a first jaw and a second jaw, a first end of the first jaw connected to a first end of the second jaw via a first hinge, and a second end of the first jaw connected to a second end of the second jaw via a second hinge, whereby the first jaw and the second jaw are movable between an insertion configuration and an initial deployment configuration, where in the insertion configuration the first jaw and the second jaw are spaced apart to receive tissue therebetween, and where in the initial deployment configuration the first jaw and the second jaw are drawn toward each other to grasp tissue therebetween. At least one of the first and second hinges is biased to pull the clip toward the initial deployed configuration. The first and second elongated members are releasably coupled to the clip at their distal ends and movably connected to the adapter, such that longitudinal movement of the first and second elongated members relative to the adapter moves the clip between an open insertion configuration, an initial deployed configuration, a review configuration, and a final deployed configuration, where the initial deployed configuration moves the clip toward a closed configuration just distal to the adapter, the review configuration separates the clip from the distal end of the endoscope a selected distance so that the clip is visible through the endoscope, and the final deployed configuration releases the clip from the elongated member in the closed configuration. A control element is connected to and extends proximally from the proximal ends of the first and second elongated members.

[0017] In one embodiment, the system may further include a coil extending proximally from the adapter and configured to slidably receive the control element therein, and an actuation assembly including a handle member and a spool mounted thereon and longitudinally movable relative thereto. The handle member may be connected to a proximal end of the coil, and the spool may be connected to a proximal end of the control element such that the spool is moved relative to the handle member to move the clip between an open insertion configuration, an initial deployment configuration, a review configuration, and a final deployment configuration.

[0018] The present embodiment is also directed to a method for treating tissue. A clip is inserted into a target area of ​​a body lumen via an endoscope, the clip being mounted onto the distal end of the endoscope shaft via an adapter in an open insertion configuration in which the jaws of the clip are spaced apart. Suction is applied through the working channel of the endoscope, thereby drawing tissue into the channel of the adapter and between the jaws of the clip. The clip is moved from the open insertion configuration to an initial deployed configuration by reducing tension along an extension member, the distal end of which is releasably coupled to the clip, thereby allowing the clip to slide distally along a tapered outer surface along the distal portion of the adapter to which the clip is attached. The extension member, whose distal end is releasably coupled to the clip, is moved distally relative to the endoscope shaft such that the clip is moved distally away from the distal end of the adapter toward a review configuration in which the clip is visible through the endoscope. The clip is moved from the review configuration to a final deployed configuration by releasing the clip from the extension member. [Brief explanation of the drawings]

[0019] [Figure 1] FIG. 1 illustrates a perspective view of a system according to an exemplary embodiment of the present disclosure. [Figure 2] FIG. 2 shows a perspective view of an adapter according to the system of FIG. [Figure 3]FIG. 3 shows a side view of the adapter of FIG. [Figure 4] FIG. 4 shows a longitudinal side view of the distal portion of the system of FIG. 1 in an insertion configuration. [Figure 5] FIG. 5 shows a longitudinal side view of the distal portion of the system of FIG. 1 in an initial deployed configuration. [Figure 6] FIG. 6 shows a transparent perspective view of the distal portion of the system of FIG. 1 in an initial deployed configuration. [Figure 7] FIG. 7 shows a perspective view of the distal portion of the system of FIG. 1 in a review configuration. [Figure 8] FIG. 8 shows a perspective view of the distal portion of the system of FIG. 1 in the final deployed configuration. [Figure 9] FIG. 9 shows a longitudinal side view of the actuation assembly of the system of FIG. [Figure 10] FIG. 10 shows a longitudinal cross-sectional view of the actuation assembly of the system of FIG. [Figure 11] FIG. 11 shows a perspective view of a distal portion of a system according to another exemplary embodiment of the present disclosure. [Figure 12] FIG. 12 shows an enlarged perspective view of the distal portion of the system of FIG. [Figure 13] FIG. 13 shows a partially transparent perspective view of the distal portion of the system of FIG. [Figure 14] FIG. 14 shows a longitudinal side view of the distal portion of the system of FIG. [Figure 15] FIG. 15 shows a longitudinal side view of a distal portion of a system according to another exemplary embodiment of the present disclosure. [Figure 16] FIG. 16 shows an enlarged perspective view of the distal portion of the system of FIG. [Figure 17] FIG. 17 shows a longitudinal side view of a distal portion of a system according to yet another exemplary embodiment of the present disclosure. [Figure 18] FIG. 18 shows an enlarged perspective view of the distal portion of the system of FIG. [Figure 19] FIG. 19 shows a longitudinal side view of the distal portion of the system of FIG. 17 in the final deployed configuration. [Figure 20] FIG. 20 shows a partial longitudinal cross-sectional view of a distal portion of a system according to another exemplary embodiment of the present disclosure. [Figure 21] FIG. 21 shows a perspective view of a releasable coupling according to the system of FIG. [Figure 22] FIG. 22 shows a perspective view of a releasable coupling according to an alternative embodiment of the system of FIG. [Figure 23] FIG. 23 shows a longitudinal side view of a distal portion of a system according to yet another exemplary embodiment of the present disclosure. [Figure 24] FIG. 24 shows an enlarged perspective view of the distal portion of the system of FIG. [Figure 25] FIG. 25 shows a longitudinal side view of a distal portion according to another exemplary embodiment of the present disclosure. [Figure 26] FIG. 26 shows an enlarged perspective view of the distal portion of the system of FIG. [Figure 27] FIG. 27 shows a plan view of a clip according to a system according to another exemplary embodiment of the present disclosure. [Figure 28] FIG. 28 shows a perspective view of the adapter and extension member according to the system of FIG. [Figure 29] FIG. 29 shows a partial enlarged perspective view of the adapter and extension member of FIG. [Figure 30] FIG. 30 illustrates a partial enlarged perspective view of an adapter and an extension member according to another exemplary embodiment of the present disclosure. [Figure 31] FIG. 31 shows a perspective view of a system according to yet another exemplary embodiment of the present disclosure. [Figure 32] FIG. 32 shows a plan view of a clip according to the system of FIG. DETAILED DESCRIPTION OF THE INVENTION

[0020] The present disclosure can be further understood with reference to the following description and the accompanying drawings, in which like elements are referred to with the same reference numerals. The present disclosure relates to a clipping system, and more particularly to an over-the-scope endoscopic clipping system in which the initial placement of a clip can be viewed and adjusted prior to its final deployment. An exemplary embodiment of the present disclosure includes a clip mountable onto the distal end of an endoscope via an adapter, the clip being releasably coupled to an extension member such that the clip can be moved between an insertion configuration, an initial deployed state, and a review configuration in which the clip can be viewed before final deployment.

[0021] In the insertion configuration, the clip is mounted on the adapter in a proximal position that maintains the clip's position in the insertion configuration, ready to receive tissue between the jaws while minimizing obstruction of the endoscopic visual system's field of view. The insertion configuration is configured to facilitate endoscope insertion into a target site adjacent the tissue to be clipped, while the system allows the clip to be deployed and clipped onto tissue in the initial deployment configuration. The device allows the endoscope to be pulled proximally away from the clip and the tissue to be clipped while the clip remains coupled to the device in the review configuration. As the endoscope is pulled proximally while the clip remains in place on the target tissue, the field of view of the endoscopic visual system expands to show the clip and the tissue thereby clipped, allowing the operator to determine whether the clip's position is desired or needs adjustment.

[0022] When the operator determines that the clip is positioned as desired, it is deployed and clipped onto the target tissue, leaving it in place. If the operator determines that the clip's position needs to be adjusted, the endoscope and its associated adapter are moved distally to a position adjacent the clip. The clip is then pulled proximally on the adapter to reopen it, and the clip is pulled proximally past the distal end of the adapter to force the clip open against its natural bias as it slides proximally back onto the adapter and returns to the insertion configuration. After the clip is removed from the tissue and returned to the insertion configuration, the operator can reposition the endoscope and device as desired, draw the target tissue into the adapter (e.g., under suction or grasping tools applied through the working channel of the endoscope), and once again deploy the clip from the adapter onto the target tissue in its original deployed position. The endoscope is again pulled proximally, with the clip still attached to the device, to move the device back to the review configuration.

[0023] The position of the clip and clipped tissue is again observed, and this process may be repeated until the clip is positioned as desired. Once the operator confirms that the tissue over which the clip will be closed is the desired portion of tissue, the clip may be deployed and released from the device and endoscope, as described below. It will be understood by those skilled in the art that the terms proximal and distal, as used herein, are intended to refer to directions toward and away from the user of the device, respectively.

[0024] 1-10 illustrate a clipping system 100 for treating tissue defects and / or perforations in accordance with an exemplary embodiment of the present disclosure. As shown in FIG. 1, clipping system 100 includes a clip 102 configured to be attached to a distal end 106 of an endoscope shaft of an endoscope 104 via an adapter 108. Clip 102 is releasably coupled to a pair of elongated members 110 configured such that, when moved relative to an endoscope shaft 124, elongated members 110 move clip 102 between an insertion configuration, an initial deployed configuration, a review configuration, and a final deployed configuration.

[0025] In the insertion configuration, the clip 102 is mounted onto the adapter 108, which holds the clip 102 in an open position, and the jaws 118 of the clip 102 are spread apart so that the tissue to be clipped can be pulled through the clip 102 between the jaws 118. As described below, the clip 102 can be pushed distally from the insertion configuration to the initial deployed configuration via a deployment element that pushes the clip 102 distally along and away from the adapter 108 until the clip 102 moves distally away from the adapter 108. At this point, the resistance offered by the adapter 108 to closing the jaws 118 is removed, and the jaws 118 spring closed under the natural bias of the clip 102 (e.g., at hinge 122).

[0026] In this initial deployed configuration, the clip 102 remains connected to the system 100 via the extension member 110. The adapter 108 and clip 102 can then be physically separated to move the system 100 to a review configuration. As described in more detail below, tissue can be drawn into the clip 102 when the clip 102 is in the insertion configuration. Once the operator believes that the desired portion of tissue (i.e., the tissue to be clipped) has been drawn into the clip 102, the clip 102 can be moved distally away from the adapter 108, causing the jaws 118 to snap closed over the tissue drawn through the clip 102 and clip the tissue. The clip 102 remains coupled to the system 100 via the extension member, while the endoscope 104 and adapter 108 can be moved proximally away from the clip 102, which remains clipped onto the tissue. This allows the operator to expand the field of view of the endoscope so that the clip 102 and the clipped tissue can be more clearly viewed, and the tissue surrounding the clip 102 and the clipped tissue can also be viewed, to determine whether the clip 102 has clipped onto the target tissue as desired. This configuration, in which the adapter 108 and endoscope 104 are pulled proximally relative to the clip 102 to better observe the clip 102, is the review configuration.

[0027] For example, in the review configuration, the clip 102 is moved distally relative to the adapter 108 to separate the clip 102 from the distal end 106 of the endoscope shaft 124 a distance selected to allow the operator (e.g., a surgeon) to confirm whether the clip 102 has clipped onto the target tissue as desired, using a view of the clip 102 provided to the operator via the optics of the endoscope 104. If desired, the operator can view the clip from a different perspective, as permitted by the surrounding tissue. If the user determines that the clip 102 has not clipped onto the target tissue as desired, the user may move the endoscope 104 distally on the extension member 110 so that the distal end of the adapter 108 approaches and eventually contacts the proximal side of the clip 102. The contact between the distal end of the adapter 108 and the proximal side of the clip 102, and the increased tension applied to the extension member 110, moves the clip proximally on the adapter 108, causing the jaws 118 to separate and the clip to return to the insertion configuration.

[0028] Once the jaws 118 are opened, the clip 102 is released from the clipped tissue so that the clip 102 can be repositioned against the target tissue. This process can then be repeated until the operator confirms that the clip 102 is clipped onto the target tissue as desired. At this point, the operator can move the clip 102 from the review configuration to the final deployed configuration by disengaging the clip 102 from the extension member 110, as described in further detail below. Movement of the clip 102 between the insertion configuration, initial deployed configuration, review configuration, and final deployed configuration can be controlled via an actuation assembly 112 at the proximal end of the endoscope shaft 124, as described in further detail below.

[0029] The clip 102 can be attached to any standard endoscope 104 via an adapter 108 sized, shaped, and configured to fit over the distal end 106 of an endoscope shaft 124 of the endoscope 104. As will be appreciated by those skilled in the art, the endoscope shaft 124 is configured to be inserted through a body lumen to a target area within the body lumen and, therefore, must be sufficiently flexible to navigate the tortuous path of the body lumen. As shown in Figures 2-3, the adapter 108 extends from the proximal end 126 to the distal end 128 and includes a channel 130 extending therethrough.

[0030] In one embodiment, the adapter 108 is substantially tubular and has a circular cross-sectional area. The proximal portion 132 of the adapter 108 is configured to mount over the distal end 106 of the endoscope shaft 124, and the distal portion 134 of the adapter 108 is configured to receive the clip 102 thereon in an insertion configuration. Accordingly, the inner diameter of the channel 130 along the proximal portion 132 of the adapter 108 is sized, shaped, and configured to correspond to the outer diameter of the endoscope shaft 124 at the distal end 106, so that the adapter 108 can be mounted thereon via, for example, a friction fit. The outer diameter of the distal portion 134 is sized, shaped, and configured to receive the clip 102 thereon in an open configuration, as described in further detail below.

[0031] In one exemplary embodiment, distal portion 134 tapers from a larger outer diameter at its proximal end 135 to a smaller outer diameter at the distal end 128 of adapter 108 and may include a plurality of longitudinally extending flattened portions 152 distributed around the outer surface 136 of adapter 108. Each of flattened portions 152 extends along at least a portion of the length of distal portion 134 and covers a portion of the outer periphery (e.g., circumference) of distal portion 134.

[0032] In one example, the outer surface 136 includes four flat portions 152 distributed around the circumference of the distal portion 134. In this embodiment, the flat portions 152 are equally sized and spaced apart from one another around the circumference of the distal portion 134. It will be understood by those skilled in the art that these flat portions 152 reduce friction between the clip 102 and the distal portion 134 of the adapter 108, facilitating movement of the clip 102 between an insertion configuration and an initial deployment configuration, as described in further detail below. Although the adapter 108 is shown and described as including four flat surfaces 152 evenly spaced along the outer surface 136 of the distal portion 108, those skilled in the art will understand that the adapter 108 may include any number of flat surfaces 152 along the distal portion 134 distributed around the adapter 108 in any of a variety of configurations, so long as the flat surfaces 152 facilitate distal movement of the clip 102 along and away from the distal portion 134 of the adapter 108, and facilitate pulling the clip 102 proximally from an initial deployment configuration back onto the adapter 108 and proximally to an insertion configuration thereon. The distal portion 134 of this embodiment includes a plurality of protrusions 144 extending radially into the channel 130 of the adapter 108 from a curved portion 153 of the distal portion 134 that extend between adjacent flat surfaces 152.

[0033] In one exemplary embodiment, the distal surface 154 of each of these curved portions 153 is angled relative to the longitudinal axis of the adapter 108 such that when the clip 102 is pulled proximally from the initial deployed configuration so that the jaws 118 abut against the distal surfaces 154, the angle of these protrusions 144 facilitates reopening of the jaws 118 against their natural bias. The protrusions 144 may aid in aligning the orientation of the clip 102 relative to the adapter 108. That is, the jaws 118 slide proximally over the protrusions 144 to open the jaws 118 so that the clip 102 can be released from the clipped tissue and slid proximally over the adapter 108 back to the insertion configuration.

[0034] In another embodiment, the adapter 108 includes a tab 138 extending from an outer surface 136 of the adapter 108 toward its distal end 128, thereby forming a groove 140 along the distal portion 134 between the tab 138 and the outer surface 136. In the insertion configuration, the clip 102 of this embodiment is mounted onto the distal portion 134 with one of the jaws 118 received in the groove 140. The tab 138 also includes a hole 142 extending therethrough. The hole 142 is configured to receive a deployment element (not shown), such as a thread, strand, or other similar element, used to move the clip 102 proximally along the adapter 108 and away from the adapter 108 from the insertion configuration to the initial deployed configuration. A first end of the deployment element may be tied or otherwise secured to tab 138, for example, via hole 142, such that the deployment element extends from tab 138, across groove 140, through the working channel of endoscope 104, through channel 130 of adapter 108, and to a second end that is coupled to proximal assembly 112.

[0035] In one exemplary embodiment, the deployment element extends into the channel 130 through an opening in the channel 130 at the distal end 128 of the adapter 108. In another embodiment, the deployment element extends into the channel 130 through a corresponding hole 174 extending through the wall of the distal portion 134 of the adapter 108. The corresponding hole 174, in this embodiment, is coaxially aligned with the hole 142 extending through the tab 138 and communicates with the channel 130. In the insertion configuration, the deployment element is relaxed and extends across the groove 140 from the tab 138 to the working channel of the endoscope 104 proximal to a portion of the clip 102. When it is desired to move the clip 102 from the insertion configuration to the initial deployed configuration, the operator applies tension to the deployment element such that the tensioned deployment element moves distally relative to the clip 102, pushing the clip 102 distally from the adapter 108.

[0036] Although the exemplary embodiment shows and describes the adapter 108 as including the tab 138, in some embodiments, the distal portion 134 of the adapter 108 may be sufficiently tapered from the proximal end 135 of the adapter 108 to the distal end 128 of the adapter 108 such that the adapter 108 does not require the tab 138 to move the clip 102 from the open insertion configuration to the initial deployed configuration. Rather, the taper of the distal portion 134 biases the clip 102 toward the initial deployed configuration. However, the clip 102 may remain attached on the distal portion 134 in the open configuration as long as sufficient proximal tension is applied to the extension member 110 such that the extension member 110 holds the clip 102 in place on the adapter 108. When this tension is removed from the extension member 110, the natural bias of the clip 102 draws the jaws 118 toward each other, pushing the clip 102 distally over the tapered surface of the adapter 108 as the extension member 110 is pulled distally with the clip 102, until the clip 102 slides off the distal end of the adapter 108. As the extension member 110 moves distally relative to the endoscope shaft 124 and the tension along it is reduced, the clip 102 is allowed to slide distally along the distal portion 134 toward the initial deployed configuration.

[0037] Clip 102 includes a pair of jaws 118 connected to one another via hinges 122 that allow the jaws 118 to move relative to one another between an open configuration in which the jaws 118 are separated from one another and a closed configuration in which the jaws 118 are moved toward one another. Each of the jaws 118 may extend along a curve from a first end 125 to a second end 127 such that the first ends 125 of the jaws 118 are connected to one another via a first one of the hinges 122 and the second ends 127 of the jaws 118 are connected to one another via a second one of the hinges 122.

[0038] According to one exemplary embodiment, each hinge 122 may be a living hinge that is substantially C-shaped, with the curve of the C extending toward and between the pair of jaws 118. The hinges 122 may be spring-loaded to bias the jaws 118 toward the closed configuration. In one exemplary embodiment, each of the jaws 118 includes gripping features 120, such as teeth, such that tissue can be grasped between the jaws 118 via the gripping features 120 when the jaws 118 are moved toward each other toward the closed configuration.

[0039] Each of the jaws 118 extends along a curve such that when the clip 102 is mounted on the distal portion 134 of the adapter 108 in the insertion configuration, as shown in FIG. 4 , each of the jaws 118 extends around diametrically opposed portions of the adapter 108, such that an outer surface 136 of the adapter 108 maintains the clip 102 in an open configuration. In the open configuration, the jaws 118 are spaced apart from one another so that target tissue can be drawn into the adapter between the jaws 118 for clipping. When the clip 102 is moved distally away from the adapter 108, the clip 102 is freed to return to a closed state (due to the bias of the clip 102) over tissue drawn into the adapter (e.g., via a suction or grasping device inserted through the working channel of the endoscope 104), as shown in FIGS. 5-6 . Thus, when distal portion 134 is sufficiently tapered, clip 102 is held in the insertion configuration by proximal tension applied to extension member 110, which is coupled to clip 102 and applies a proximal force thereto.

[0040] Releasing tension from extension member 110 pulls clip 102 distally over adapter 108 until the bias of clip 102 draws jaws 118 toward each other and disengages clip 102 from distal end 128 of adapter 108, allowing clip 102 to slide distally along distal portion 134 and jaws 118 to snap closed on tissue drawn into adapter 108 and reach an initial deployed configuration just distal to distal end 128 of adapter 108. Those skilled in the art will appreciate that hinge 122 and / or jaws 118 of clip 102 may be formed from any of a variety of materials, so long as hinge 122 biases jaws 118 toward the closed configuration, as described above. In one example, portions of clip 102 (e.g., hinge 122) may be formed from a shape memory alloy, such as, for example, Nitinol.

[0041] As described above, movement of the clip 102 between the insertion configuration, initial deployment configuration, review configuration, and final deployment configuration is facilitated via an extension member 110 releasably coupled to the clip 102. In one exemplary embodiment, the extension member 110 is releasably coupled to a hinge 122 of the clip 102. In this embodiment, the clipping system 100 includes two extension members 110, each extending from a distal end 148 releasably coupled to a corresponding hinge 122 of the clip 102 to a proximal end 156. The proximal ends 156 of the two extension members 110 are connected to each other and to a control element 158, which extends proximally therefrom to the actuation assembly 112. The extension member 110 and / or the control element 158 ​​may be comprised of a flexible strand, filament, or coil formed, for example, from a metal or a polymer, as will be understood by those skilled in the art.

[0042] In one exemplary embodiment, distal portions 160 of the pair of extension members 110 extend along opposite sides of the distal portion 134 of the adapter 108 such that each extension member 110 engages a corresponding one of the hinges 122 of the clip 102. In one exemplary embodiment, each distal portion 160 of the pair of extension members 110 forms a loop 146 at its distal end 148 for engaging a C-shaped hinge 122 of the clip 102. Each loop 146 hooks onto the C-shaped portion of a corresponding one of the hinges 122 such that the loop 146 engages the hinge 122 via, for example, a friction fit. The distal ends 148 of the extension members 110 in this embodiment are biased to move (when unconstrained) away from the longitudinal axis of the adapter 108 and move radially away from the clip 102 to the released configuration, as shown in FIG. 8 . That is, when the extension member 110 is disengaged from the clip 102, the extension member 110 bounces radially away from the clip 102 to completely disengage from the clip 102, thereby allowing the endoscope 104, adapter 108, and extension member 110 to be removed from the body while leaving the clip 102 in its final deployed configuration clipped onto the target tissue.

[0043] When coupled to clip 102, loop 146 hooks into C-shaped hinge 122, which prevents distal end 148 of extension member 110 from springing radially outward, thus remaining engaged with C-shaped hinge 122. When clip 102 is determined to be in the desired position clipped onto the target tissue (e.g., when an operator viewing clip 102 from a review configuration determines that clip 102 is positioned as desired), adapter 108 and endoscope 104 are advanced distally over extension member 110 until the adapter contacts or is positioned adjacent clip 102. At this point, extension member 110 is extended distally.

[0044] Because clip 102 is prevented from moving further distally by the tissue being clipped, further distal pressure applied to extension member 110 causes loop 146 to move distally (e.g., overcome the friction of the loop friction-fitting onto clip 102) until loop 146 passes the distal end of C-shaped hinge 122. At this point, loop 146 is no longer constrained by hinge 122 and springs radially outward away from clip 102, eventually separating clip 102 from system 100 and leaving the clip in its final deployed configuration. It will be understood by those skilled in the art that when distal ends 148 are no longer constrained by hinge 122, loops 146 move away from one another such that the distance between distal ends 148 is greater than when distal portion 160 of extension member 110 was constrained by clip 102.

[0045] The distal portion 160 of the extension member 110 extends along the outer surface 136 of the distal portion 134 of the adapter 108, while the proximal portion 162 of the extension member 110 extends through corresponding channels 166 that extend longitudinally through a wall 168 of the proximal portion 132 of the adapter 108, as shown in FIG. 6 . In one embodiment, the proximal portion 132 includes four channels 166 for accommodating the two strands that form each of the loops 146. The channels 166 extend through the wall 168 and converge at the point where the proximal ends 156 of the extension member 110 connect to each other and to the control element 158. The channel 166 is configured to slidably receive a portion of the extension member 110 such that longitudinal movement of the control element 158 ​​relative to the endoscope shaft 124 moves the extension member 110 distally and / or proximally to move the clip 102 between an open insertion configuration, an initial deployment configuration, a viewing configuration, and a final deployment configuration.

[0046] In one exemplary embodiment, the control element 158 ​​extends translationally through a coil 150 that extends between the adapter 108 and the actuation assembly 112. The coil 150 may, for example, extend from the proximal end 126 of the adapter 108 and extend along the endoscope shaft 124. The coil 150 may be coated with a material (e.g., PTFE), which may be braided or unbraided, to reduce friction between the endoscope shaft 124 and the coil 150. It will be appreciated that the coil 150 remains longitudinally fixed relative to the endoscope shaft 124, while the control element 158 ​​is longitudinally movable relative thereto to facilitate movement of the extension member 110. The control element 158 ​​may likewise be coated with a friction-reducing material, such as, for example, PTFE / MDX, to reduce friction between the coil 150 and the control element 158.

[0047] 4 , control element 158 ​​maintains a desired proximal tension along it, such that clip 102, releasably coupled to extension member 110, remains mounted on adapter 108 in the open configuration. When it is desired to clip tissue, the tissue is drawn into the distal end of adapter 108 (e.g., by applying suction or a grasping element through the working channel of endoscope 104), and control element 158 ​​is moved distally relative to coil 150 and endoscope shaft 124, reducing the proximal tension from control element 158. This allows clip 102 to slide distally along tapered outer surface 136 until clip 102 moves distally away from distal end 128 of adapter 108 and snaps closed on the tissue drawn into adapter 108. At this point, clip 102 is in an initial deployed configuration closed over the tissue just distal to distal end 128 of adapter 108, as shown in FIGS.

[0048] To change system 100 to the review configuration, as shown in FIGURE 7, coil 150 is moved proximally relative to control element 158, causing endoscope shaft 124 to slide proximally over extension member 110 and adapter 108 to move proximally relative to clip 102. Once clip 102 is moved away from distal end 106 of endoscope shaft 124 a distance selected so that clip 102 is visible through endoscope 104 (as permitted by the surrounding anatomy), the operator views clip 102, the clipped tissue, and the surrounding tissue.

[0049] If, during viewing, it is desired to adjust the position / placement of the clip 102, the endoscope 104 and adapter 108 are slid distally over the extension member 110 until the protrusion 144 on the distal end of the adapter 108 contacts the clip 102. Proximal tension applied to the extension member at this point pulls the clip 102 against the protrusion 144, causing the angled surfaces of the protrusion 144 to pull the jaws 118 apart against their natural bias as the jaws 118 and clip 102 move proximally over the adapter 108. Once the jaws 118 are fully open, the clipped tissue is released and the clip 102 can be pulled proximally over the adapter 108 to the insertion configuration. That is, as proximal tension on extension member 110 pulls the clip proximally against prongs 144, the column strength of endoscope 104 and adapter 108 applies a distal force to jaws 118 (via distal end 128 of adapter 108), forcing jaws 118 open, thereby pulling clip 102 further proximally against adapter 108. The operator can then reposition clip 102 as desired and repeat this process until clip 102 is clipped onto tissue as desired. Once the operator confirms that clip 102 has been deployed as desired, system 100 can release clip 102 in the final deployed configuration, as described above.

[0050] According to one exemplary embodiment, as shown in FIG. 8 , when it is desired to release clip 102 from extension member 110 in the final deployed configuration, extension member 110 is moved distally relative to clip 102 (via control element 158) until loop 146 is moved distally, as described above, out of engagement with hinge 122. Once loop 146 is moved distally of, for example, C-shaped hinge 122 and out of engagement therewith, distal ends 148 of extension member 110 are released from hinge 122 and allowed to return to their biased configuration in which distal ends 148 move radially away from one another. With distal ends 148 extending radially away from one another, extension member 110 is no longer coupled to the clip and can be moved proximally away from clip 102 without re-engaging with clip 102. Thus, the clip 102 can be left in the body and clipped to the target tissue while the endoscope 104 is removed therefrom.

[0051] Although clip 102 is described and illustrated as having a C-shaped hinge 122, it will be understood by those skilled in the art that hinge 122 of clip 102 can have any of a variety of shapes and configurations, so long as hinge 122 is configured to bias jaws 118 of clip 102 toward the closed configuration, as described above. Similarly, it will be understood by those skilled in the art that distal end 148 of extension member 110 can have any of a variety of shapes and configurations, so long as distal end 148 is configured to releasably engage hinge 122, as described above.

[0052] As described above, the actuation assembly 112 can be used to move the extension member 110 relative to the endoscope shaft 124 to move the clip 102 between an insertion configuration, an initial deployment configuration, a review configuration, and a final deployment configuration. As shown in FIGS. 9-10 , the actuation assembly 112 includes a handle member 114 and a spool 116 slidably mounted thereon. The handle member 114 is connected to a proximal end 170 of the coil 150, while the spool 116 is connected to a proximal end 172 of the control element 158. Thus, movement of the spool 116 relative to the handle member 114 can correspondingly move the control element 158 ​​relative to the coil 150, thereby moving the clip 102 relative to the endoscope 104 between the open insertion configuration, the initial deployment configuration, the review configuration, and the final deployment configuration, as described above.

[0053] According to an exemplary method for tissue closure utilizing clipping system 100, the distal end of endoscope 104, including adapter 108 and clip 102 as described, is inserted into a living body (e.g., through a body lumen (e.g., the GI tract) accessed by a naturally occurring body orifice) to reach a target area within the body lumen adjacent the tissue to be clipped. As described above, in the insertion configuration, clip 102 is attached to distal end 106 of endoscope shaft 124 via adapter 108, as shown in FIG. 4, such that jaws 118 are separated from each other in the insertion configuration.

[0054] As will be understood by those skilled in the art, clip 102 is guided to a target area via endoscope 104 (e.g., using the vision system of endoscope 104) and positioned adjacent to target tissue. A portion of the tissue may be drawn into channel 130 of adapter 108 (e.g., via suction or a grasping instrument applied through the working channel of endoscope 104), thereby drawing the target tissue into channel 130 of adapter 108. Clip 102 is then moved distally over and removed from adapter 108, causing jaws 118 to snap closed and clip clip 102 onto tissue in channel 130, as shown in FIGS. 5-6 . As described above, the clip 102 can be moved distally over the adapter 108, for example, by moving the spool 116 distally relative to the handle member 114, thereby allowing the clip 102 to slide distally along the tapered outer surface 136 of the distal portion 134 of the adapter 108 and biasing the jaws 118 of the clip 102 toward an initial deployed configuration.

[0055] It will be understood by those skilled in the art that the suction and / or gripping of tissue in this initial deployed configuration obstructs the imaging / optical lenses of the endoscope 104, thereby preventing the user from visualizing and / or confirming whether the desired portion of tissue (i.e., the target tissue) has been properly clipped. However, moving the clip 102 away from the distal end 106 of the endoscope shaft 124 eliminates this obstruction by moving the clipped tissue away from the distal end of the endoscope 104, thereby allowing the operator to view the clip 102 and the clipped tissue. When in the initial deployed configuration, the clip 102 can be moved toward the viewing configuration, as shown in FIG. 7 , by moving the endoscope shaft 124 proximally relative to the clip 102, e.g., by moving the handle member 114 proximally relative to the spool 116, while allowing the extension member 110 to unwind until the clip 102 is sufficiently removed from the endoscope 104 to provide the desired viewing. In particular, moving the coil 150 proximally relative to the extension member 110 allows the endoscope 104 to be pulled proximally away from the clip 102, creating a selected distance between the clip 102 and the distal end 106 of the endoscope shaft 124 such that the clip 102 can be visualized through the optics of the endoscope 104.

[0056] If, upon visualization, the user determines that clip 102 requires adjustment and / or repositioning relative to the target tissue, endoscope 104 is slid distally over extension member 110, for example, by holding spool 116 stationary and moving handle member 114 distally, until distal end 128 of adapter 108 is adjacent clip 102. Extension member 110 can then be pulled proximally to pull clip 102 over distal portion 134 of adapter 108 into the insertion configuration and release the clipped tissue, as described above.

[0057] The clip 102 may then be repositioned against the target tissue, and this new tissue may be drawn into the channel 130 of the adapter 108, as described above. The clip 102 may then be moved distally away from the adapter 108 to clip this new portion of tissue in the same manner as described above. The system 100 may again be moved to the review configuration, and when the operator determines that the desired tissue has been clipped as desired, the clip 102 may be moved to the final deployed configuration as described above. This process may be repeated as many times as necessary until the user confirms that the clip 102 has been clipped onto the target tissue as desired.

[0058] Once the user confirms that the target tissue has been clipped as desired, the clip 102 may be moved from the review configuration to the final deployed configuration, as shown in FIG. 8 , by releasing the clip 102 from the extension member 110. As described above, to release the clip 102, the control element 158, and thereby the extension member 110, is moved further distally relative to the endoscope shaft 124. In the review configuration, the clip 102 is clipped onto the target tissue, thereby abutting the tissue surface, so that moving the extension member 110 further distally also moves the extension member 110 distally relative to the clip 102. The extension member 110 is moved distally relative to the clip 102 until the distal end 148 of the extension member 110 disengages from the hinge 122 of the clip 102.

[0059] According to one embodiment, the extension member 110 may be moved distally relative to the clip 102 until the loops 146 at the distal end 148 disengage from the hinge 122. Once the loops 146 are released from, for example, the C-shaped hinge 122, the distal ends 148 are allowed to return to their biased configuration and move radially away from one another. Thus, the extension member 110 and endoscope 104 may be withdrawn from the body, leaving only the clip 102 clipped to the target tissue.

[0060] 11-14 , clipping system 200 according to another exemplary embodiment is substantially similar to clipping system 100, except as described in more detail below. System 200 includes a clip 202 that is attached to a distal end 206 of an endoscope shaft 242 of an endoscope 204 via an adapter 208 and configured to be inserted into a target area within the body, for example, via a body lumen. Similar to clipping system 100, clip 202 is releasably coupled to a pair of extension members 210 that facilitate movement of clip 202 relative to endoscope shaft 242 and adapter 208 between an insertion configuration, an initial deployment configuration, a review configuration, and a final deployment configuration.

[0061] In the insertion configuration, the clip 202 is mounted onto a distal portion 234 of the adapter 208, thereby maintaining the jaws 218 of the clip 202 in the insertion configuration. The clip 202 can be moved from the insertion configuration to the initial deployment configuration by moving the clip 202 distally along the adapter 208 and away from the adapter 208, thereby allowing the jaws 218 to spring back to a closed state under their bias to the initial deployment configuration just distal to the adapter 208. The system 100 is then moved to the review configuration by moving the endoscope shaft 224 proximally relative to the clip 202 as the extension member 210 is unreeled, thereby separating the distal end 206 of the endoscope shaft 224 from the clip 202 a selected distance so that the clip 202 is visible through the endoscope 204 while the clip 202 remains coupled to the system 200 via the extension member 210.

[0062] In this embodiment, each of the extension members 210 is connected to one of the jaws 218 of the clip 202 rather than the hinge 222 connecting the jaws 218 to one another. Thus, movement of the clip 202 to its final deployed configuration is achieved via a different mechanism than that described with respect to the clip 102.

[0063] In this exemplary embodiment, clip 202 is substantially similar to clip 102 and includes jaws 218 connected to one another via hinges 222 such that clip 202 is movable between an insertion configuration in which jaws 218 are separated from one another to receive tissue therebetween and an initial deployed configuration in which jaws 218 are moved toward one another to grasp tissue received therebetween. Each of jaws 218 in this embodiment extends along a curve from a first end 225 to a second end 227, with first ends 225 of each of jaws 218 connected to one another via one of hinges 222 and second ends 227 connected to one another via a second one of hinges 222. Each of jaws 218 in this embodiment further includes an opening 276 extending therethrough, which is sized and shaped to receive a portion of a corresponding one of extension members 210 to form a releasable connection between each of jaws 218 and its corresponding extension member 210. According to one example, opening 276 is formed midway between first end 225 and second end 227 of each of jaws 218. However, it will be understood by those skilled in the art that opening 276 may be formed anywhere on each of jaws 218, so long as opening 276 is configured to receive a corresponding one of extension members 210 therein.

[0064] Each of the extension members 210 extends from a distal end 248 that is releasably coupled to the clip 202 through an opening 276 to a proximal end 256. However, rather than including a loop at the distal end 248, each of the extension members 210 is configured as, for example, a metallic or polymeric filament, strand, or coil that includes an expansion member 246 (e.g., an expanding ball) coupled to the distal end 248 via a severable connection. The distal end 248 of each extension member 210 is inserted through a corresponding one of the openings 276. The expansion member 246 is then connected to the distal end 248 to prevent the extension member 210 from inadvertently separating from the clip 202 while the clip 202 moves between the insertion configuration, the initial deployment configuration, and the review configuration.

[0065] However, the clip 202 can be moved from the review configuration, in which the clip 202 is clipped onto tissue, toward the final deployed configuration by pulling the extension member 210 proximally relative to the adapter 208 until the expansion member 246 is pressed proximally against the jaws 218. When a force applied thereto exceeds a predetermined threshold force, the expansion member 246 separates, detaches, or otherwise decouples from the distal end 248, thereby allowing the extension member 210 and endoscope 204 to be completely separated from the clip 202 and removed from the body while leaving the clip 202 in place clipped onto the target tissue.

[0066] Similar to extension member 110, distal portion 260 of extension member 210 extends along the outer surface 236 of distal portion 234 of adapter 208, while proximal portion 262 of extension member 210 extends longitudinally through a channel 266 that extends through wall 258 of proximal portion 232. In one embodiment, distal portion 260 of extension member 210 extends along diametrically opposed sides of distal portion 234. However, it will be understood by one skilled in the art that distal portion 260 may extend along any portion of distal portion 234.

[0067] In this embodiment, the adapter may include two channels 266 configured to accommodate the proximal portion 260 of the extension member 210. The channels 266 converge at a point where the proximal ends 256 of the extension member 210 meet and connect to one another. As described above with respect to clipping system 100, a control element (not shown) extends proximally from the proximal end 256 of the extension member 210 to an actuation assembly, for example, substantially similar to actuation assembly 112, such that movement of the extension member 210, and therefore movement of the clip 202, can be controlled via movement of the control element relative to the endoscope shaft 242. Similar to clipping system 100, the control element may extend through a coil 250 extending between the proximal end 226 of the adapter 208 and the actuation assembly, as described above with respect to system 100.

[0068] It will be understood by those skilled in the art that clipping system 200 may be utilized in a manner substantially similar to clipping system 100. In particular, clip 202 may be moved between an insertion configuration, an initial deployment configuration, and a review configuration in a manner substantially similar to clip 102. However, when it is desired to move clip 202 to a final deployment configuration, extension member 210 is pulled proximally relative to clip 202 until the tension on extension member 210 generates a force that exceeds a predetermined threshold force at which expansion member 246 is released from distal end 248 of extension member 210. Once expansion member 246 is separated from distal end 248, extension member 210 is removed from opening 278, such that extension member 210 and endoscope 204 may be removed from the body while leaving clip 202 in place clipped onto the target tissue.

[0069] 15-16 , a clipping system 300 according to another exemplary embodiment of the present disclosure may be substantially similar to the clipping system 200 described above, except for the differences detailed below. The clip system 300 may be utilized in a manner substantially similar to that described for the clip systems 100 and 200, whereby the clip 302 is movable between an insertion configuration, an initial deployed configuration, and a review configuration via an extension member 310 that is releasably coupled to the clip 302 via an expansion member 346 at the distal end 348 of the extension member 310, substantially as described above. However, rather than being moved to the final deployed configuration by applying a tension to the extension member 310 that exceeds a predetermined threshold force, the clipping system 300 further includes a string 380 connected to the expansion member 346 for disengaging the expansion member 346 from the distal end 348 of the extension member 310.

[0070] Similar to the extension members 210 and clips 202 of clip system 200, the distal ends 348 of the extension members 310 each include an expansion member 346 releasably coupled to a corresponding one of the distal ends 348, such that when it is desired to move the clip 302 to its final deployed configuration, each of the expansion members 346 is disengaged from its corresponding distal end 348 to allow removal of the extension member 310 from an opening 378 extending through the jaw 318 of the clip 302. Each string 380 extends from a distal end 381 connected to a corresponding one of the expansion members 346 to, for example, an actuation assembly at the proximal end of the endoscope shaft 324, as described above. Thus, when it is desired to move the clip 302 to its final deployed configuration, a user applies a proximal force on the string 380 against the clip 302, thereby separating the expansion member 346 from the distal end 348 of the extension member 310. Once the expansion member 346 is no longer coupled to the distal end 348, the extension member 310 is pulled proximally away from the opening 378, thereby releasing the clip 302 from the extension member 310 in the final deployed configuration.

[0071] In one embodiment, the expansion member 346 is a substantially U-shaped element that fits onto one of the distal ends 348 and is held in place (e.g., via a friction fit) until it is desired to disengage it therefrom. However, it will be understood by those skilled in the art that the expansion member 346 can be formed in any of a variety of shapes and configurations, so long as the expansion member 346 can be fitted onto the distal end 346 so as to be releasable via the string 380. It will also be understood by those skilled in the art that the expansion member 346 can be releasably coupled to the distal end 348 via a friction fit, adhesive, or other coupling mechanism, so long as the expansion member 346 is releasable therefrom via the string 380.

[0072] Although clipping system 300 is described and illustrated as including string 380, one skilled in the art will understand that clipping system 300 may include any of a variety of removal elements extending from expansion member 346 to the actuation assembly. The removal element may include, for example, any thread, filament, or strand configured to pull expansion member 346 away from distal end 348 of extension member 310.

[0073] 17-19, clipping system 400 according to another exemplary embodiment may be substantially similar to any of clipping systems 100, 200, and 300 described above, differing only as described below. Clipping system 400 similarly includes a clip 402 attachable to an endoscope via an adapter 408, and clip 402 movable between an insertion configuration, an initial deployment configuration, a review configuration, and a final deployment configuration via an extension member 410. Clipping system 400 is substantially similar to clipping system 200, except as described below.

[0074] The extension members 410, in this embodiment, include coils 411 extending from a proximal end to a distal end 448. The coils 411 extend from the interconnected proximal ends to a control element extending proximally therefrom to control movement of the extension members 410, substantially as described above with respect to clipping systems 100-300. However, each extension member 410 further includes a wire 446 extending distally from the distal end 448, the wire 446 configured to be looped through an opening 478 extending through a corresponding jaw 418 of the clip 402. In particular, the wire 446 may be looped through the opening 478 and a distal end 447 of the wire 446 attached to the distal end 448 of the coil 411, such that the extension members 410 are coupled to the clip 402 via the loop formed through the wire 446.

[0075] The distal end 447 of the wire 446 may be attached to the distal end 448 of the coil 448 via, for example, welding, crimping, or adhesive. This attachment is configured such that when it is desired to disengage the extension member 410 from the clip 402 and move the clip 402 toward its final deployed configuration, a user can exert a proximal force along the extension member 410 against the clip 402 (which is clipped onto the target tissue) until the attachment is broken so that the wire 446 is removed from the opening 478. One skilled in the art will understand that the attachment is broken when the force applied thereto exceeds a predetermined threshold. Once the attachment is broken, the extension member 410 and endoscope can be removed from the body, if desired, leaving only the clip 402 clipped onto the target tissue.

[0076] 20-21 , a clipping system 500 according to yet another exemplary embodiment is substantially similar to the clipping systems 200-400 described above, and includes a clip 502 attachable to a distal end 506 of an endoscope 504 and movable between an insertion configuration, an initial deployment configuration, a review configuration, and a final deployment configuration via an extension member 510 releasably coupled to the clip 502. The clipping system 500 may be substantially similar to the clipping systems described above, except as described in more detail below. The proximal and distal portions 562, 560 of the extension member 510 are interconnected via a releasable coupling 564, in this embodiment, configured to separate, break, or otherwise release, allowing the clip 502 to be moved toward the final deployment configuration.

[0077] The proximal and distal portions 562, 560 of the extension member 510 are each comprised of a separate strand of string, for example, that are releasably coupled to one another via a releasable coupling 564. Similar to the extension members described above with respect to clipping systems 100-400, the proximal end of the proximal portion 562 may be connected to one another and to a control element 558 for controlling movement of the extension member 510 relative to the endoscope 504. According to one exemplary embodiment, the releasable coupling 564 includes a retaining element 586. The retaining element 586 in this embodiment is C-shaped and / or bracket-shaped such that an interior space 590 of the retaining element 586 is open to its exterior along one side. Retention element 586 extends from a proximal end 587 that is fixedly attached to distal end 563 of proximal portion 562, and from a distal end 588 that includes a U-shaped slot 589 via which distal portion 560 is releasably coupled to retention element 586. An interior 590 extends between proximal end 587 and distal end 588, such that U-shaped slot 589 is in communication with both interior space 590 and the exterior of retention element 586.

[0078] Each distal portion 560 of the extension member 510 extends from an enlarged proximal end 559 to a distal end 561 that is non-releasably coupled to the clip 502 via an opening 578 that extends through the corresponding jaw 518 of the clip 502. The distal end 561 may be non-releasably connected to the jaw 518, for example, via a ball. Those skilled in the art will understand that the ball is sized so that it cannot pass through the opening 578. In the coupled configuration, the enlarged proximal end 559 may be received within an interior 590 of the retention element 586, such that a portion of the distal portion 560 of the extension member 510 distal to the proximal end 559 extends through the distal end 588 of the retention element 586 via a slot 589. Similar to the distal end 561, the enlarged proximal end 559 may be configured as a ball sized to have a diameter greater than the width of the slot 589, such that the enlarged proximal end 559 cannot pass longitudinally through the slot 589.

[0079] The retaining element 586 of each releasable coupling 564 is slidably received within a channel 566 extending through the proximal portion 532 of the adapter 508 when the clip 502 is in the open insertion, initial deployment, and review configurations. The enlarged proximal end 559 of the distal portion 560 is maintained within an interior space 590 of the retaining element 586 via the proximal and distal ends 587, 588 of the retaining element 586 and via the interior surface of the channel 566 when in the open insertion, initial deployment, and review configurations.

[0080] However, when it is desired to move clip 502 toward the final deployed configuration, extension member 510 is moved further distally relative to adapter 508 until retention element 586 is moved distally beyond the distal end of channel 566, thereby releasing enlarged proximal end 559 from within channel 566 and no longer retained within interior space 590 via channel 560. Once enlarged proximal end 559 is released from retention element 586, proximal portion 562 of extension member 510 and endoscope 504 may be removed, leaving clip 502 with attached distal portion 560 inside the body, clipped on target tissue.

[0081] Although the distal portion 560 of the extension member 510 is described and illustrated as non-releasably coupled to the jaw 518 of the clip 502 via a ball, it will be understood by those skilled in the art that the distal portion 560 may be non-releasably coupled to the clip 502 via any of a variety of coupling mechanisms. In an alternative embodiment, as shown in FIG. 22 , the distal portion 560′ of the extension member 510′ may be configured as a strand looped through an opening 578′ in the corresponding jaw 518′ of the clip 502′. Similar to the extension member 510, the distal portion 560′ may have an enlarged proximal end 559′ via which the distal portion 560′ is releasably coupled to a retaining element 586′ of a releasable coupling 564′ for coupling the distal portion 560′ to the proximal portion 562′ of the extension member 510′.

[0082] According to another exemplary embodiment, as shown in FIGS. 23-26 , a clipping system 600 may be substantially similar to any of the clipping systems described above. The clipping system 600 includes a clip 602 configured to be mountable onto a distal end 606 of an endoscope shaft 624 via an adapter 608. The clip 602 is movable relative to the adapter 608 and the endoscope shaft 624 via an extension member 610, which facilitates movement of the clip 602 between an insertion configuration, an initial deployment configuration, a review configuration, and a final deployment configuration. Similar to the clipping system 200, each of the pair of extension members 610 is connected to a corresponding jaw 610 of the clip 602. However, the clipping system 600 further includes an elastic band 680 for disengaging the extension member 610 from the clip 602 and moving the clip 602 toward the final deployment configuration, as described in further detail below.

[0083] Similar to extension member 210, extension member 610 extends from a proximal end 656 to a distal end 648. The proximal ends 656 are connected to one another and to control elements extending proximally therefrom. The distal ends 648 each include an expansion member 646 thereon. However, the expansion members 646 are fixed thereon and cannot be removed from the distal ends 648. The distal ends 648 are biased toward a radially outward position in this embodiment. In other words, the distal ends 648 are biased away from one another, thereby causing each of the distal ends 648 to extend radially away from the longitudinal axis of the adapter 608.

[0084] Similar to clip 202, each of jaws 618 includes an opening 678 extending therethrough for releasably receiving a portion of a corresponding one of extension members 610 therein. However, each of openings 678 includes a first portion 682 sized and shaped to prevent passage of expansion member 246 therethrough and a second portion 684 sized and shaped to allow passage of expansion member 246 therethrough. Openings 678 are configured such that first portion 682 is radially outward relative to second portion 684. Thus, in the coupled configuration, a portion of extension member 610 immediately proximal to expansion member 646 is received within first portion 682, and expansion member 646 abuts jaw 118 and is prevented from passing therethrough.

[0085] The clip 602 can be moved between an insertion configuration, an initial deployment configuration, and a review configuration to grasp target tissue in a manner substantially similar to that described with respect to the clipping system above. In the insertion configuration, the initial deployment configuration, and the review configuration, the elastic band 680 extends around a portion of the adapter 608. Once it has been determined that the target tissue has been grasped as desired by the clip 602, the elastic band 680 is moved distally away from the adapter 608, such that the elastic band 680 extends around the extension member 610 distal to the adapter 608 and draws the extension members 610 toward each other, thereby moving the distal ends 648 toward each other and allowing the expansion member 646 to pass through the second portion 684 of the opening 678. The extension member 610 and endoscope 604 can then be removed from the body, leaving the clip 602 grasped on the target tissue.

[0086] It will be understood by those skilled in the art that the elastic band 680 may be deployed from the adapter 608 via any of a variety of mechanisms, so long as the elastic band 680 is movable distally on the extension member 610 to move the extension member 610 from the first portion 682 to the second portion 684 of the opening 678. In one example, a distal portion of a thread or other strand may be wound around a portion of the elastic band, such that when the proximal end of the strand is pulled proximally by a user, the distal portion of the strand begins to unwind and the elastic band 680 is rolled distally along the distal portion 634 of the adapter 608 and away from the tapered outer surface 636.

[0087] The illustrative embodiment shows and describes an elastic band 680 for moving the extension members 610 to facilitate final deployment of the clip 602. It will be understood by those skilled in the art that any of a variety of mechanisms can be utilized to move the clip 602 to final deployment, so long as the extension members 610 can be constrained toward one another so that the expansion member 646 at the distal end 648 can pass through the second portion 684 of the opening 678. In another embodiment, for example, a snare can be deployed around the extension members 610, distal to the adapter 608, to draw the extension members 610 toward one another, thereby moving the distal end 648 into the second portion of the opening 678 and thus removing it from the clip 602.

[0088] As shown in Figures 27-29, a clipping system according to yet another exemplary embodiment may be substantially similar to the clipping system described above, including a clip 702, as shown in Figure 27, configured to be attached to the distal end of an endoscope via an adapter 708, as shown in Figures 28-29. Similar to the previously described clipping system, the clip 702 is movable relative to the adapter 708 and the endoscope between an insertion configuration, an initial deployment configuration, a review configuration, and a deployment configuration via an extension member 710 releasably coupled to a jaw 718 of the clip 702.

[0089] However, as described in more detail below, the extension member 710 according to this embodiment is keyed to a portion of the adapter 708, such that when the extension member 710 is moved distally relative to the adapter, a distal portion 760 of the extension member 710 is forced to extend radially outward to disengage the clip 702 from the extension member 710 in the final deployed configuration. It will be understood by those skilled in the art that the clipping system 700 can be substantially similar to the clipping systems described above, except as detailed below.

[0090] Similar to clip 602, clip 702 is comprised of jaws 718, as shown in FIG. 27, each jaw 718 including an opening 778 defined through first and second portions 782, 784 extending therethrough for releasably engaging a corresponding one of extension members 710. However, in this embodiment, first portion 782 is disposed radially inward of second portion 784 and is sized and shaped to have a smaller width than enlarged end 746 at distal end 748 of extension member 710. Second portion 784 is sized, shaped, and configured to allow enlarged end 746 to pass therethrough.

[0091] The extension members 710 extend from a proximal end to a distal end 748 that includes an expansion member 746. The proximal ends may be connected to each other and to a control element, as described with respect to clipping systems 100-600, that extends proximally therefrom to an actuation assembly for moving the clip 702 between an insertion configuration, an initial deployment configuration, a viewing configuration, and a final deployment configuration. A distal portion 760 of each extension member 710 may taper toward the distal end 748. The proximal portion 762 of the extension member 710 has a larger diameter than the distal portion 760.

[0092] Similar to the clipping systems described above, the proximal portion 762 of the extension member 710 is slidably received within a corresponding channel 766 extending through the proximal portion 732 of the adapter 708. However, in this embodiment, the adapter 708 includes a key feature 780 movably received within the adapter 708 at the distal end of each of the channels 766. In the insertion, initial deployment, and review configurations, the key feature 780 is in a first position relative to the channel 766 of the adapter 708. The key feature 780 is maintained within this first portion via a friction fit with a portion of the channel 760. In the final deployment configuration, the key feature 780 is moved to a second position in which the key feature is moved radially outward relative to the longitudinal axis of the adapter 708. As described in more detail below, the larger diameter of the proximal portion 762 of the extension member 710 urges the key feature toward this second position.

[0093] In the insertion configuration, initial deployment configuration, and review configuration, the distal portion 760 of the extension member 710 is slidably moved along the key feature 780, and the distal end 748 of the extension member 710 is releasably coupled to the opening 778 via the first portion 782 of the opening. However, when it is desired to release the clip 702 from the extension member 710 in the final deployment configuration, the adapter 708 is moved proximally relative to the extension member 710 until the larger diameter of the proximal portion 762 engages the ramped surface 786, moving the key feature 780 from the first position toward the second position. The extension member 710, pressed against the ramped surface, also moves radially outward, moving the distal end 748 from within the first portion 782 of the opening 748 to the second portion 784 of the opening 778. Thus, enlarged end 746 is permitted to pass through opening 778, thereby removing extension member 710 therefrom, leaving only clip 702 clipped onto the target tissue.

[0094] While the illustrative embodiment specifically describes moving the distal portion 760 radially outward to release the enlarged end 746 from the opening 778 and leave the clip 702 in its final deployed configuration, one skilled in the art will understand that the clipping system 700 may be modified such that the distal portion 760 of the extension member 110 must move radially inward relative to the longitudinal axis of the adapter 708 to release from the opening 778. Notably, in another embodiment, when the larger diameter of the proximal portion 762 engages the angled surface 786 of the key feature 780, the key feature 780 is moved radially inward, and the distal portion 760, which is pressed against it, is also moved radially inward. It will be understood by one skilled in the art that the first portion 782 and second portion 784 of the opening 787 are correspondingly configured.

[0095] 30 illustrates another exemplary embodiment of an adapter 808 and extension member 810 that may be used in combination with clip 702 of the clipping system described above. Extension member 810 may be substantially similar to extension member 710 described above. However, rather than a key feature including a beveled surface at the distal end of channels 866 extending through proximal portion 832 of adapter 808, each of channels 866 of adapter 808 includes a key feature configured as a sphere 880 having a channel 886 extending therethrough for slidably receiving distal portion 860 of one of extension members 810 therein.

[0096] Sphere 888 is received in a socket 888 formed in the distal end of a corresponding one of channels 866, such that sphere 888 is rotatable between a first position in which the longitudinal axis of channel 886 of sphere 880 is substantially coaxially aligned with the longitudinal axis of channel 866, and a second position in which the longitudinal axis of channel 886 of sphere 880 is oblique to the longitudinal axis of channel 866 of adapter 808. A portion of socket 88 includes an oblique surface 887 extending therealong, such that sphere 880 rotates from the first position to the second position when sphere 880 is moved distally relative thereto.

[0097] In the insertion configuration, initial deployment configuration, and review configuration, the ball 880 is in a first position relative to the adapter 808 such that the distal portion 860 of the extension member 810 is slidably received through the channel 886 of the ball 880 and the distal end 848 of the extension member 810 is releasably coupled to the opening 778 of the clip 702 via the first portion 782 of the opening 778. However, when it is desired to release the clip 702 from the extension member 810 in the final deployment configuration, the adapter 808 is moved proximally relative to the extension member 810 until the larger diameter of the proximal portion 862 of the extension member 810 engages a portion of the ball 880, forcing the ball 880 distally against the angled surface 887 of the socket 888 and moving the ball 880 from the first position to the second position. Thus, distal portion 860 of extension member 810 is angled relative to proximal portion 862 of extension member 810, causing distal portion 860 to be moved radially outward relative to the longitudinal axis of adapter 808. When sphere 880 is moved toward the second position, distal end 848 is moved into second portion 884 of opening 878, thereby allowing enlarged end 846 to pass through second portion 884 and release clip 702 from extension member 810.

[0098] While the illustrative embodiment specifically describes radially outward movement of the distal portion 860 of the extension member 810 to release the enlarged end 846 from the opening 878, leaving the clip 702 in its final deployed configuration, those skilled in the art will understand that the clipping system may be modified such that the distal portion 860 of the extension member 810 moves radially inward relative to the longitudinal axis of the adapter 808 via an opposite rotation of the sphere 880. It will be understood by those skilled in the art that the first and second portions 782, 784 of the opening 778 in this embodiment are correspondingly configured to facilitate release of the extension member 810 therefrom when the distal portion 860 is moved in a radially inward direction relative to the longitudinal axis of the adapter 808.

[0099] 31-32, a clipping system according to yet another exemplary embodiment may be substantially similar to the clipping systems described above and includes a clip 902 configured to be mountable onto the distal end of an endoscope via an adapter 908 attached to the distal end of the endoscope. The clip 902 is movable relative to the adapter 908 between an insertion configuration, an initial deployment configuration, a review configuration, and a final deployment configuration via an extension member 910 releasably coupled to the clip 902.

[0100] As described above with respect to systems 100-800, clip 902 is moved between the insertion configuration, the initial deployment configuration, and the review configuration by longitudinally moving extension member 910 relative to adapter 908. However, clip 902 is released from extension member 910 and moved toward the final deployment configuration via rotation of extension member 910, as described in further detail below. Those skilled in the art will appreciate that clipping system 900 is substantially similar to the clipping systems described above, except as described below.

[0101] The clip 902 may be substantially similar to the clips 102-702 and includes a pair of jaws 918, each jaw 918 including an opening 978 extending therethrough for releasably engaging the distal end 948 of the extension member 910. However, in this embodiment, the openings 978 may be keyed to the expansion member 946 at the distal end 948 of the extension member 910. For example, each of the openings 978 may be configured as a slot-like opening sized and shaped to receive, for example, the flattened expansion member 946 at the distal end 948 of the extension member 910. The slot-like openings 978 are sized, shaped, and configured to allow the flattened expansion member 946 to pass therethrough when the flattened expansion member 946 is in an unlocked orientation relative to the slot-like openings 978. When the flattened expansion member 946 is rotated relative to the opening 978 from an unlocked orientation about the longitudinal axis of the extension member 910 to a locked orientation different from the first orientation, the expansion member 946 cannot pass through the slotted opening 978, thereby causing the distal end 948 of the extension member 910 to be releasably coupled thereto.

[0102] In one exemplary embodiment, the rotation angle between the first and second positions of the flattened expansion member 946 relative to the slotted opening 978 may be approximately 90 degrees. It will be understood by those skilled in the art that the rotation of the extension member 910 between the first and second orientations relative to the opening 978 may have any of a variety of angles, so long as the expansion member 946 is rotatable between locked and unlocked orientations relative to the opening 978.

[0103] In one embodiment, the flattened expansion member 946 may be substantially symmetrical in shape, and the size and shape of the slotted opening 978 may substantially correspond to the shape of the flattened expansion member 946. However, it will be understood by those skilled in the art that the opening 978 and flattened expansion member 946 may have any of a variety of shapes and sizes, so long as the slotted opening 978 and expansion member 946 are keyed to one another, for example, so long as rotation of the flattened expansion member 946 relative to the slotted opening 978 moves the extension member 910 and clip 902 between locked and unlocked orientations.

[0104] Similar to the clipping devices described above, the proximal portion 960 of the extension member 910 is received within a channel extending through the proximal portion of the adapter 908, and the distal portion 960 of the extension member 910 extends distally therefrom along an outer surface of the distal portion when the adapter 908 engages the clip 902. The clipping system 902 may be moved between an open insertion configuration, an initial deployment configuration, and a viewing configuration via longitudinal movement of the extension member 910 relative to the adapter 908, substantially as described above with respect to the previous clipping systems. In the open insertion configuration, the initial deployment configuration, and the review configuration, the expansion member 946 is in a locked configuration relative to the opening 978. However, when it is desired to move the clip 902 toward its final deployed configuration by releasing it from the extension member 910, the adapter 908 is moved proximally relative to the extension member 910 and further distally relative to the adapter 908 until the keyed feature 980 extending along the proximal portion 960 of the extension member 910 engages with a corresponding keyed (e.g., threaded) portion of the channel of the adapter 908 and rotates from a locked configuration to an unlocked configuration relative to the channel and opening 978.

[0105] It will be apparent to those skilled in the art that various modifications can be made in the present disclosure without departing from the scope of the disclosure.

Claims

1. 1. A clipping system for treating tissue, comprising: an adapter extending longitudinally from a proximal end to a distal end configured to be mounted over the distal end of the insertion device; a clip including a first jaw and a second jaw, a first end of the first jaw connected to a first end of the second jaw via a first hinge and a second end of the first jaw connected to a second end of the second jaw via a second hinge, the first jaw and the second jaw being movable between an insertion configuration and an initial deployed configuration, wherein in the insertion configuration the clip is mounted on the adapter such that the first jaw and the second jaw are spaced apart from each other to receive tissue therebetween, and in the initial deployed configuration the first jaw and the second jaw are drawn toward each other to grasp tissue therebetween, and at least one of the first hinge and the second hinge is biased to pull the clip toward the initial deployed configuration; a first extension member releasably coupled to the clip and movably connected to the adapter to enable movement of the clip relative to the adapter from the insertion configuration to the initial deployment configuration; the first extension member is configured to allow the adapter to be pulled proximally away from the clip while the extension member remains coupled to the clip to place the system in a review configuration wherein the clip is physically separated from the adapter to facilitate visual observation of the clip; the first extension member is operable to retract the clip proximally on the adapter; the clip is forced open as it is retracted on the adapter to release it from the tissue being clipped; and the first extension member is configured to release the clip therefrom in a final deployed configuration when the clip is observed to be clipped in a desired position.

2. 2. The system of claim 1, further comprising a second extension member releasably coupled to the clip and movably connected to the adapter, the second extension member configured to remain coupled to the clip while the clip is moved toward the initial deployment configuration and while the system is moved to the review configuration, the second extension member operable in cooperation with the first extension member to proximally retract the clip on the adapter from one of the review configuration and the initial deployment configuration and to release the clip therefrom in the final deployment configuration.

3. 3. The system of claim 2, wherein the proximal end of the first elongated member and the proximal end of the second elongated member are connected to one another and to a control element extending proximally therefrom to a proximal end accessible to a user of the system.

4. 4. The system of claim 1, wherein a distal portion of the adapter to which the clip can be attached in the insertion configuration is tapered toward the distal end of the adapter so as to reduce tension along the first extension member, thereby causing the clip to slide distally along the distal portion of the adapter from the insertion configuration toward the initial deployment configuration.

5. 5. The system of claim 4, wherein the distal portion of the adapter includes a flat portion along its outer surface and a protrusion extending radially inward from an inner surface of the distal portion of the adapter, the flat portion for reducing friction between the clip and the adapter when the clip is moved distally along the flat portion from an open configuration toward the initial deployed configuration, and the protrusion configured to engage a portion of the clip when the clip is moved from the initial deployed configuration toward the open configuration.

6. 6. The system of claim 3, wherein the distal end of each of the first and second elongated members includes a loop configured to hook onto a portion of a corresponding one of the first and second hinges, the distal end of each of the first and second elongated members being biased radially away from the longitudinal axis of the adapter, wherein when the loop of the first and second elongated members hook onto the first and second hinges, respectively, the distal ends of the first and second elongated members are constrained toward an engaged configuration, and when the distal ends of the first and second elongated members disengage from the first and second hinges, the distal ends of the first and second elongated members spring laterally outward to release the clip therefrom in the final deployed configuration.

7. The system of any one of claims 1 to 5, wherein the first jaw includes an opening extending therethrough for engagement with the first elongate member.

8. 8. The system of claim 7, wherein the first elongated member includes an expansion member releasably connected to the distal end of the first elongated member, the first elongated member being releasably coupled to the opening of the first jaw via the expansion member.

9. 9. The system of claim 8, wherein the clip is movable from the review configuration to the final deployed configuration by pressing the expansion member proximally against the first jaw and pulling the first elongated member proximally relative to the adapter until a force exerted thereon exceeds a predetermined threshold such that the expansion member disengages from the distal end of the first elongated member.

10. 9. The system of claim 8, further comprising a strand connected to the expansion member and extending proximally therefrom, wherein the clip is movable from the review configuration to the final deployed configuration by pulling the strand proximally until the expansion member disengages from the distal end of the first extension member.

11. 8. The system of claim 7, wherein the first elongated member includes a coil extending from a proximal end to a distal end and a wire extending from the distal end of the coil and looped through the opening of the first jaw, the distal end of the wire being releasably attached to the distal end of the coil such that the first jaw is releasably coupled to the clip via the wire.

12. 8. The system of claim 7, wherein the first elongated member includes a proximal portion and a distal portion connected to one another via a releasable connection, the distal portion connected to the clip via the opening extending through the first jaw.

13. 13. The system of claim 12, wherein the releasable connection includes a retaining element having a first end fixedly attached to the proximal portion of the first elongated member and a second end releasably attached to the distal portion of the first elongated member, the distal portion of the first elongated member being released therefrom when the retaining element is moved distally beyond the distal end of the adapter.

14. 1. A clipping system for treating tissue, comprising: an endoscope including a shaft extending longitudinally from a proximal end to a distal end; an adapter including a proximal portion mounted onto the distal end of the shaft of the endoscope and a distal portion extending distally from the proximal portion, the distal portion tapering toward its distal end; a clip configured to be mounted onto the distal portion of the adapter, the clip including a first jaw and a second jaw, a first end of the first jaw connected to a first end of the second jaw via a first hinge and a second end of the first jaw connected to a second end of the second jaw via a second hinge, the first jaw and the second jaw movable between an insertion configuration and an initial deployed configuration, wherein in the insertion configuration the first jaw and the second jaw are spaced apart from each other to receive tissue therebetween and wherein in the initial deployed configuration the first jaw and the second jaw are drawn toward each other to grasp tissue therebetween, and at least one of the first hinge and the second hinge is biased to pull the clip toward the initial deployed configuration; first and second elongated members releasably coupled at their distal ends to the clip and movably connected to the adapter, wherein longitudinal movement of the first and second elongated members relative to the adapter moves the clip between the insertion configuration, an initial deployed configuration, a review configuration, and a final deployed configuration, wherein in the initial deployed configuration, the first and second jaws are moved toward each other just distal to the adapter, the review configuration separates the clip from the distal end of the endoscope a selected distance so that the clip is visible through the endoscope, and the final deployed configuration, wherein the clip is released from the elongated members with the first and second jaws closed over tissue received therebetween; a control element connected to a proximal end of the first elongated member and a proximal end of the second elongated member and extending proximally therefrom; A system comprising:

15. a coil extending proximally from the adapter and configured to slidably receive the control element therein; Actuating Assembly and 15. The system of claim 14, further comprising: the actuation assembly including a handle member and a spool mounted thereon and longitudinally movable relative thereto, the handle member connected to a proximal end of the coil, the spool connected to a proximal end of the control element, the spool being moved relative to the handle member to move the clip between an open insertion configuration, the initial deployment configuration, the review configuration, and the final deployment configuration.

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