Patent Description:
During endoscopic gastrointestinal (GI) procedures, the patient may be at risk of perforation of a wall of the GI tract or may require closure of the GI tract wall as part of the procedure. Hemostasis clips may be used for hemostasis of, for example, mucosal/sub-mucosal defects, bleeding ulcers, arteries, polyps, diverticula, along with closure of luminal tract perforations. Depending on the size of the defect, multiple clips may be used.

<CIT> and <CIT> disclose clipping systems.

Certain optional features of the invention are defined in the dependent claims. The present disclosure relates to a reloadable clipping system for treating tissue, comprising a clip including a pair of clip arms, each of the clip arms extending from a proximal end to a distal end, proximal ends of the clip arms slidably received within a channel of a capsule to be moved between an open configuration and a closed configuration. A proximal end of the capsule includes a plurality of connecting elements extending proximally therefrom, each of the connecting elements including a hook along a proximal portion thereof. An applicator includes an elongated flexible member and a control member extending therethrough. The control member includes a distal end configured to be connected to the clip arms to move the clip assembly between the open configuration and the closed configuration. A distal end of the elongated flexible member includes a bushing including a first ramped portion tapering to a distal end of the bushing and a necked portion extending proximally from the first ramped portion. A proximal end of the first ramped portion includes a lip defined via a recess extending between an interior surface of the first ramped portion and an exterior surface of the necked portion, the lip configured to engage the hook when the connecting elements are crimped thereover.

In one embodiment, the bushing may include a second ramped surface flaring proximally outward from a proximal end of the necked portion.

In one embodiment, the connecting elements may be formed of a metal material configured to permit an elastic deformation thereof during a loading of the clip when the connecting elements are slid proximally along an exterior surface of the first ramped portion and a plastic deformation of the connecting elements when a compressive force exerted on the connecting elements exceeds a predetermined threshold value so that connecting elements slide proximally along the second ramped portion of the bushing toward a deployed configuration in which the bushing is releasable from therebetween.

In one embodiment, the reloadable clipping system may further comprise a cartridge including a space sized and shaped to house the clip therein, in the open configuration, and a longitudinal slot extending proximally from the space, the longitudinal slot sized and shaped to receive a distal portion of the applicator therein.

In one embodiment, the longitudinal slot may include a crimping feature configured to engage the distal portion of the connecting elements when the connecting elements are moved proximally therepast so that the hook of the connecting elements crimp the hook over the lip of the first ramped portion.

In one embodiment, the crimping feature may include a ramped surface tapering toward a distal end so that the ramped surface exerts a radially inward and a distal force to the hook so that a tip of the hook is received within the cavity defining the lip.

In one embodiment, the longitudinal slot may include a stop along a portion thereof configured to engage a portion of the bushing to prevent the bushing from moving distally therebeyond.

In one embodiment, the first and second ramped portions may define substantially conically shaped portions of the bushing while the neck portion extends along a cylindrical portion of the bushing.

In one embodiment, the hook may extend along a substantially J-shape so that a tip of the hook extends toward a distal direction.

The present disclosure may be further understood with reference to the following description and the appended drawings, wherein like elements are referred to with the same reference numerals. The present disclosure relates to a clipping system and, in particular, relates to a reloadable endoscopic clipping system, in which a clip may be loaded onto a distal end of an applicator prior to an endoscopic procedure. Once a clip has been deployed at a desired target area in the body, the applicator may be reloaded with a new clip. Although shed parts (e.g., parts that are left in a body upon deployment of the clip) generally pass naturally from the body, shed parts may become trapped in larger defects after closure.

Exemplary embodiments of the present disclosure comprise a clip including clip arms slidable within a capsule to move between an open configuration and a closed configuration to clip tissue, as desired. A proximal end of the capsule includes a pair of connecting elements extending proximally therefrom and configured to be crimped over a portion of the applicator via a crimping feature in a cartridge, which holds and stores the clip prior to loading of the clip onto the applicator. The crimped connection between the clip and the applicator facilitates a direct releasable connection with the applicator, which minimizes or eliminates the potential for shed parts upon deployment of the clip. It will be understood by those of skill in the art that the terms proximal and distal as used herein, are intended to refer to a direction toward and away from, respectively, a user of the device.

As shown in <FIG>, a reloadable clipping system <NUM> comprises a clip <NUM> configured to be loaded onto an applicator <NUM> prior to insertion of the system <NUM> into a body to clip target tissue therein. The clip <NUM> includes a pair of clip arms <NUM>, proximal ends <NUM> of which are slidably received within a capsule <NUM> so that the clip arms <NUM> may move between an open configuration, in which distal ends <NUM> of the clip arms <NUM> are separated from one another, and a closed configuration, in which distal ends <NUM> are drawn toward one another to grip tissue. A proximal end <NUM> of the capsule <NUM> includes a pair of connecting elements <NUM> extending proximally therefrom and configured to be crimped over, for example, a bushing <NUM> of the applicator <NUM> during a loading of the clip <NUM> onto the applicator <NUM>.

Prior to loading of the clip <NUM> into the applicator <NUM>, the clip <NUM> is stored in a cartridge <NUM> including a crimping feature <NUM> so that when a distal portion of the applicator <NUM> is inserted into the cartridge <NUM>, the capsule <NUM> may be drawn proximally over the bushing <NUM> until the crimping feature <NUM> of the applicator <NUM> engages the connecting elements <NUM> to crimp the connecting elements <NUM> over a portion of the bushing <NUM>. During loading of the clip <NUM>, an enlarged distal end <NUM> of a control member <NUM> of the applicator <NUM> is also coupled to the clip arms <NUM> so that longitudinal movement of the control member <NUM> relative to the capsule <NUM> moves the clip <NUM> between the open and closed configurations.

As will be described in further detail below, once the target tissue has been clipped, as desired, a user (e.g., physician) of the system <NUM> initiates a deployment process in which a compressive load is exerted on the connecting elements <NUM>, causing the connecting elements <NUM> to move away from a centerline of the capsule <NUM>, toward a deployed configuration, so that the bushing <NUM> is released therefrom. In the deployed configuration, the connecting elements <NUM> are plastically deformed without fracture to release the bushing <NUM> therefrom so that deployment of the clip <NUM> does not leave any shed parts in the body. The applicator <NUM> is configured so that, after deployment of the clip <NUM>, a new clip <NUM> may be loaded onto the applicator <NUM> so that the same applicator <NUM> may be used to deliver the new clip <NUM> to a second portion of target tissue in the body. Each clip <NUM> according to this embodiment is stored in a cartridge <NUM>, which facilitates loading of the clip assembly <NUM> onto the applicator <NUM>.

As shown in <FIG>, the clip <NUM> includes the pair of clip arms <NUM>, proximal ends <NUM> of which are, in this embodiment, connected to one another via a yoke <NUM> slidably received within the capsule <NUM>. In this embodiment, the clip arms <NUM> are biased toward the open configuration so that, when not constrained by the capsule <NUM>, the clip arms <NUM> move under their natural bias to the open configuration in which the distal ends <NUM> of the clip arms <NUM> spread apart from one another to receive tissue therebetween. When the clip arms <NUM> are drawn into the capsule <NUM>, the capsule <NUM> constrains the clip arms <NUM>, holding the distal ends <NUM> together so that tissue may be gripped therebetween. The yoke <NUM> is longitudinally slidable within the capsule <NUM> to move the clip arms <NUM> proximally and distally relative to the capsule <NUM> between the open and closed configurations.

Each of the clip arms <NUM> extends from the proximal end <NUM>, connected to the yoke <NUM>, to the distal end <NUM>. The distal ends <NUM> of one or both of the clip arms <NUM> may include tips extending laterally inward toward the other clip arm <NUM> with the tips including, for example, teeth, protrusions, spikes or other structures configured to grip tissue between the distal ends <NUM>. One or both of the clip arms <NUM> may also include a locking feature configured to lock the clip arms <NUM> in the tissue gripping configuration after target tissue has been gripped as desired by the clip arms <NUM>. In one embodiment, one or both of the clip arms <NUM> includes a locking tab extending laterally outward therefrom configured to engage a portion of the capsule <NUM> when the clip arms <NUM> have been drawn into the capsule <NUM> by a predetermined distance. For example, the locking tabs may be received within correspondingly sized, shaped and positioned locking windows extending laterally into or through a wall of the capsule <NUM> to lock the clip arms <NUM> relative to the capsule <NUM>, in the tissue gripping configuration.

The yoke <NUM> is connected to the proximal ends <NUM> of the clip arms <NUM> and is configured to be connected to the enlarged distal end <NUM> of the control member <NUM>. In this embodiment, the yoke <NUM> includes a proximal portion <NUM> and a distal portion <NUM> connected to one another at a point <NUM> configured to break or separate when subject to a force exceeding a predetermined threshold value. For example, the point <NUM> may include a welding, a decreased diameter portion, or an adhesive that breaks or otherwise uncouples when sufficient force is exerted thereon. The distal portion <NUM> is configured to engage proximal portions of the clip arms <NUM> via, for example, a pair of protrusions extending therefrom and received within correspondingly sized and shaped openings extending through proximal portions of the clip arms <NUM> so that the clip arms <NUM> are held in position relative to one another.

The proximal portion <NUM> is configured to engage the enlarged distal end <NUM> of the control member <NUM>. In one embodiment, the proximal portion <NUM> includes a cavity <NUM> sized and shaped to receive the enlarged distal end <NUM> and a longitudinal slot <NUM> extending proximally from the cavity <NUM> to a proximal end <NUM> of the yoke <NUM>. The longitudinal slot <NUM> is sized and shaped to receive a portion of the control member <NUM> extending proximally from the enlarged distal end <NUM>. In one embodiment, an opening of the longitudinal slot <NUM> at the proximal end <NUM> includes an angled surface <NUM> tapering toward a distal end thereof to facilitate insertion of the enlarged distal end <NUM> distally through the longitudinal slot <NUM> and into the cavity <NUM> during loading the clip <NUM> onto the applicator <NUM>. The cavity <NUM> and the longitudinal slot <NUM> are configured so that, once the enlarged distal end <NUM> has been forced through the slot <NUM> into the cavity <NUM>, the slot <NUM> retracts in diameter to prevent the enlarged distal end <NUM> from being proximally withdrawn therefrom. Thus, longitudinal movement of the control member <NUM> relative to the capsule <NUM> moves the clip arms <NUM> between the open and the closed configurations.

The capsule <NUM> extends longitudinally from the proximal end <NUM> to a distal end <NUM> and includes a channel <NUM> extending longitudinally therethrough. The channel <NUM> is sized and shaped to slidably receive the yoke <NUM> and the clip arms <NUM> therein. As described above, the capsule <NUM> of this embodiment also includes locking structures (e.g., locking windows) for engaging corresponding locking features (e.g., locking tabs) of the clip arms <NUM>. The capsule <NUM> includes the connecting elements <NUM> which, in an initial configuration, extend proximally from the proximal end <NUM> so that the connecting elements <NUM> are substantially diametrically opposed to one another. Although the capsule <NUM> is shown and described as including two connecting elements <NUM>, it will be understood by those of skill in the art that the capsule <NUM> may include more than two connecting elements and, according to another embodiment, for example, may include four connecting elements <NUM> extending proximally from the proximal end <NUM> about a periphery thereof.

As would be understood by those skilled in the art, these connecting elements <NUM> may be distributed around a circumference of the capsule <NUM> in any desired pattern but are generally equally dispersed therearound. A distal portion <NUM> of each of the connecting elements <NUM> extends at an angle relative to the longitudinal axis of the capsule <NUM> away from the longitudinal axis of the capsule <NUM> - flaring away from a longitudinal axis of the capsule <NUM>. A proximal portion <NUM> of each of the connecting elements <NUM> includes a hook <NUM> configured to engage a corresponding portion of the bushing <NUM>. As will be described in further detail below, the proximal portion <NUM> is crimped over the bushing <NUM> so that the hook <NUM> engages the corresponding portion of the bushing <NUM>. In one embodiment, the proximal portion of the hook <NUM> extends along a substantially J-shaped curve so that a tip <NUM> of the hook <NUM> extends toward a distal direction.

As shown in <FIG>, the applicator <NUM> includes a flexible member <NUM> such as, for example, a catheter extending from a proximal end connected to a handle portion <NUM> that remains outside of the body during the clipping of target tissue, to a distal end including, for example, the bushing <NUM> for connecting the applicator <NUM> to the clip <NUM>. The control member <NUM> extends through the flexible member <NUM> from a proximal end connected to the handle portion <NUM>, which includes actuators for controlling a movement of the clip <NUM> once the clip <NUM> has been loaded onto the applicator <NUM>, to the enlarged distal end <NUM>.

In this embodiment, the bushing <NUM> is connected to the distal end of the flexible member <NUM> and is configured to be connected to the clip <NUM> via the connecting elements <NUM> of the capsule <NUM>. The bushing <NUM> extends from a proximal end <NUM> to a distal end <NUM> and includes a channel <NUM> extending therethrough. The proximal end <NUM> is connected to the distal end of the flexible member <NUM> while the distal end <NUM> is configured to engage the connecting elements <NUM>. When the bushing <NUM> is coupled to the capsule <NUM>, the channel <NUM> of the bushing <NUM> is substantially aligned with the channel <NUM> of the capsule <NUM>. The bushing includes a first ramped portion <NUM> configured to engage the connecting elements <NUM> during loading of the clip <NUM> onto the applicator <NUM> and a second ramped portion <NUM> facilitating separation of the capsule <NUM> from the bushing <NUM> during a deployment of the clip <NUM>. The first and second ramped portions <NUM>, <NUM> are, in this embodiment, connected to one another via a neck portion <NUM>. The first and second ramped portions <NUM>, <NUM> extend about a periphery of the bushing <NUM> and, in one embodiment, form substantially conical portions of the bushing <NUM>. The neck portion <NUM> similarly extends about a periphery of the bushing <NUM>, proximally from the first ramped portion <NUM> to a distal end of the second ramped portion <NUM>, along a substantially cylindrical portion of the bushing <NUM>.

An exterior surface <NUM> of the first ramped portion <NUM> tapers to the distal end <NUM> to facilitate receipt of the bushing <NUM> between the connecting elements <NUM>. The first ramped portion <NUM> includes a lip <NUM> at a proximal end thereof, the lip <NUM> defined by a space formed between an interior surface of the first ramped portion <NUM> and an exterior surface <NUM> of the neck portion <NUM>. A portion of the first ramped portion <NUM> forming the lip <NUM> has a larger diameter than the distal end <NUM> such that, as the capsule <NUM> is drawn proximally relative to the bushing <NUM> during loading of the clip <NUM>, the hook <NUM> slides along the exterior surface <NUM> of the first ramped portion <NUM> so that the connecting elements <NUM> elastically deform to accommodate the first ramped portion <NUM> therebetween. Once the hook <NUM> has moved proximally past the lip <NUM>, the connecting elements <NUM> snap radially inward reverting to their initial configuration.

In this configuration, the hook <NUM> and the first ramped portion <NUM> form a preliminary engagement in which the tip <NUM> of the hook <NUM> abuts an edge <NUM> of the lip <NUM>. As will be described in further detail below, once the capsule <NUM> and the bushing <NUM> have formed this preliminary engagement, drawing the applicator <NUM> and the clip <NUM> out of the cartridge <NUM> engages the crimping feature <NUM> of the cartridge <NUM> with the proximal portion <NUM> of the connecting elements <NUM> so that the hook <NUM> is crimped over the lip <NUM> of the first ramped portion <NUM>, loading the clip <NUM> onto the applicator <NUM>. After the hook <NUM> has been crimped over the lip <NUM>, the clip <NUM> remains coupled to the bushing <NUM> of the applicator <NUM> until deployment.

The second ramped portion <NUM> extends proximally from neck portion <NUM>, flaring outward therefrom so that a proximal end <NUM> of the second ramped portion <NUM> has a larger diameter than both the neck portion <NUM> and portion of the first ramped portion <NUM> including the lip <NUM>. Once the clip <NUM> has been clipped over target tissue as desired, the control member <NUM> is drawn proximally with respect to the capsule <NUM> until the clip arms <NUM> are locked relative to the capsule <NUM> (e.g., via locking tabs of the clip arms <NUM> received within locking windows of the capsule <NUM>) in the closed configuration. Further proximal movement of the control member <NUM> after this point draws the capsule <NUM> proximally against the bushing <NUM> so that, when a sufficient compressive force is applied to the connecting elements <NUM>, the hook <NUM> slides proximally along the second ramped portion <NUM>, moving the connecting elements <NUM> toward the deployed configuration, in a direction away from the longitudinal axis of the capsule <NUM>. The connecting elements <NUM> are plastically deformed toward the deployed configuration out of engagement with the bushing <NUM> so that the bushing <NUM> may be proximally removed from between the connecting elements <NUM> of the capsule <NUM> without leaving any shed parts in the body.

In one embodiment, the connecting tabs <NUM> are formed of a metal selected to permit the slight elastic deformation required to achieve the preliminary engagement of the connecting elements <NUM> with the first ramped portion <NUM> and which will plastically deform during deployment of the clip <NUM>. The connecting elements <NUM> may be formed of a metal such as, for example, stainless steel which may be annealed or work hardened (by stamping, drawing, extruding, etc.) so that, when crimped over the bushing <NUM>, will bear the load of the clip <NUM> moving between the open and the closed configurations without any deformations. Once a sufficient compressive force has been applied to the connecting elements <NUM>, however, the connecting tabs <NUM> will plastically deform toward the deployed configuration.

Prior to being loaded on the applicator <NUM>, the clip <NUM> of this embodiment is stored in the cartridge <NUM>, which is configured to facilitate loading of the clip assembly <NUM> on the applicator <NUM>. The cartridge <NUM>, as shown in <FIG>, is configured as a storage container including a base <NUM> and lid (not shown), within which a space <NUM> sized and shaped to house the clip <NUM> is defined. It should be noted that although <FIG> shows only the base <NUM> of the container <NUM>, a corresponding lid is coupled to the base <NUM> to completely enclose the clip <NUM>. In this embodiment, the clip <NUM> is stored within the cartridge <NUM> in the open configuration. Extending proximally from the space <NUM> is a longitudinal slot <NUM> through which the distal portion of the applicator <NUM> is inserted to be coupled to the clip assembly <NUM>, as will be described in further detail below.

In this embodiment, the longitudinal slot <NUM> includes a stop configured as a shoulder <NUM> sized to engage the proximal end <NUM> of the second ramped portion <NUM> so that the bushing <NUM> cannot be moved distally therebeyond, as shown in <FIG>. The crimping feature <NUM> is positioned immediately distal of the shoulder <NUM> within the longitudinal slot <NUM>. In this embodiment, the crimping feature <NUM> is configured as a ramped surface <NUM> flaring distally outward from the shoulder <NUM> so that the ramped surface <NUM> is angled with respect to the longitudinal axis of the capsule <NUM>. A cross-sectional area (e.g., diameter) of the longitudinal slot <NUM> at a proximal end <NUM> of the ramped surface <NUM> is smaller than a cross-sectional area (e.g., diameter) at a distal end <NUM> of the ramped surface <NUM> so that the proximal end <NUM> protrudes into the longitudinal slot <NUM>, toward a centerline thereof, to provide a crimping for the connecting elements <NUM>.

During loading of the clip <NUM> onto the applicator <NUM>, a distal portion of the applicator <NUM>, including the bushing <NUM>, is inserted through the longitudinal slot <NUM> of the cartridge <NUM> until the proximal end <NUM> of the second ramped portion <NUM> abuts the shoulder <NUM>, preventing the bushing <NUM> from moving therebeyond. In one embodiment, the control member <NUM> is then moved distally relative to the flexible member <NUM> until the enlarged distal end <NUM> of the control member <NUM> extends distally past the bushing <NUM> to engage the yoke <NUM>. Upon connection of the control member <NUM> within the yoke <NUM>, the control member <NUM> is drawn proximally relative to the flexible member <NUM> to move the clip <NUM> toward the closed configuration. Once in the closed configuration, continued proximal motion of the control member <NUM> moves the capsule <NUM> proximally relative to the cartridge <NUM> until the connecting elements <NUM> at the proximal end <NUM> of the capsule <NUM> are moved proximally over the first ramped portion <NUM>, as shown in <FIG>.

In another embodiment, the shoulder <NUM> may be positioned in such a way that the user directly engages the connecting elements <NUM> onto the bushing <NUM>, and then engages the control member <NUM> with the yoke <NUM> before finally removing the entire assembly from the cartridge <NUM> to fully crimp the clip onto the bushing <NUM>. The hook <NUM> of each of the connecting elements <NUM> slides proximally along the exterior surface <NUM> of the first ramped portion <NUM>, elastically deforming to accommodate the first ramped portion <NUM>, until the hook <NUM> moves proximally past the lip <NUM> at which point, the connecting elements <NUM> revert to their initial configuration. In particular, the hook <NUM> is snapped over the first ramped portion <NUM>, as shown in <FIG>, forming the preliminary engagement with the hook <NUM> engaging the lip <NUM>, as shown in <FIG>, with the tip <NUM> of the hook <NUM> engaging the edge <NUM> of the lip <NUM>.

The snapping of the hook <NUM> over the first ramped portion <NUM> provides tactile feedback to the user so that the user is aware that the capsule <NUM> and the bushing <NUM> have formed a preliminary engagement. The user may then draw the entire applicator <NUM> proximally relative to the cartridge <NUM> so that the capsule <NUM>, is also drawn proximally through the longitudinal slot <NUM> of the cartridge <NUM> until proximal portion <NUM> of the connecting elements <NUM> engage the crimping feature <NUM>. In particular, the hook <NUM> of the distal portion is slid proximally along the ramped surface <NUM>, as shown in <FIG>, so that the crimping feature <NUM> provides both a radially inward and distal force to the hook <NUM>, crimping the hook <NUM> over the lip <NUM> of the first ramped portion <NUM>, as shown in <FIG>.

For example, the tip <NUM> of the hook <NUM> may be received within the space defined between the exterior surface of the neck portion <NUM> and the interior surface of the ramped portion <NUM>. A remaining portion of the proximal portion <NUM> of the connecting elements <NUM> is pressed against an exterior surface of the lip <NUM> forming a crimped connection which bears the load of the clip <NUM> opening and closing. Once the clip <NUM> has been loaded onto the applicator via the crimping of the connecting elements <NUM>, further proximal motion of the applicator <NUM>, as shown in <NUM>, moves the bushing <NUM> and the capsule <NUM> proximally past the crimping feature <NUM> so that the assembled clip <NUM> and applicator <NUM> may be removed from the cartridge <NUM>.

In use, after the clip <NUM> has been loaded onto the applicator <NUM>, the clip <NUM>, in the closed configuration, is inserted into the body to a location adjacent to target tissue via, for example, a working channel of an endoscope. Once the clip <NUM> has reached the target tissue, the clip <NUM> is moved toward the open configuration to receive the target tissue between the distal ends <NUM> of the clip arms <NUM>. The clip <NUM> may be moved between the open and the closed configurations until the target tissue has been clipped between the clip arms <NUM>, as desired. Once the clip <NUM> is in the closed configuration clipping the target tissue as desired, the control member <NUM> (e.g., via actuators of the handle portion <NUM>) is moved proximally with respect to the capsule <NUM> until locking features of the clip arms <NUM> engage corresponding locking structures of the capsule <NUM>, locking the clip arms <NUM> relative to the capsule <NUM> in the closed configuration.

To free the clip <NUM> from the applicator <NUM>, the control member <NUM> is drawn further proximally until the capsule <NUM> is drawn proximally against the bushing <NUM> and a compressive load on the connecting elements <NUM> exceeds a predetermined threshold value, forcing the connecting elements <NUM>, and in particular the hooks <NUM>, to disengage from the lip <NUM> and slide proximally along the second ramped portion <NUM>. The sliding of the hooks <NUM> along the second ramped portion <NUM> plastically deforms the connecting tabs <NUM> so that they remain in a more radially outward position further from the longitudinal axis of the capsule <NUM> out of engagement with the bushing <NUM>. The bushing <NUM> may be proximally withdrawn from between the connecting elements <NUM>, leaving the clip <NUM> in place clipping the target tissue.

The user continues to exert proximal force on the control member <NUM> until the yoke <NUM> breaks, fails or otherwise separates at the point <NUM>, releasing the clip arms <NUM>, and thereby the clip <NUM>, from the control member <NUM> and locking the clip <NUM> closed over the target tissue. The entire applicator <NUM>, including the control member <NUM> and the proximal portion <NUM> of the yoke <NUM>, may then be withdrawn proximally from the body leaving the clip <NUM> clipped over the target tissue. If so desired, a new clip <NUM> may be loaded onto the applicator <NUM>, in the same manner as described above, so that the system <NUM> may then be used to clip a second portion of tissue. This process may be repeated using the same applicator <NUM> as many times as needed or desired.

Although the connecting elements <NUM> are described and shown as extending proximally from the capsule <NUM> to engage a portion of the bushing <NUM>, it will be understood by those of skill in the art that connecting elements <NUM> may similarly extend distally from a bushing of an applicator to engage a corresponding portion of a capsule of a clip. Alternatively, a coupler including crimpable connecting elements may be attached to either the capsule or the bushing to be crimped over a corresponding portion of the other of the capsule or the bushing.

Claim 1:
A reloadable clipping system (<NUM>) for treating tissue, comprising:
a clip (<NUM>) including a pair of clip arms (<NUM>), each of the clip arms extending from a proximal end to a distal end, proximal ends of the clip arms slidably received within a channel (<NUM>) of a capsule (<NUM>) to be moved between an open configuration and a closed configuration, a proximal end of the capsule including a plurality of connecting elements (<NUM>) extending proximally therefrom, each of the connecting elements including a hook (<NUM>) along a proximal portion thereof; and
an applicator (<NUM>) including an elongated flexible member (<NUM>) and a control member (<NUM>) extending therethrough, the control member including a distal end configured to be connected to the clip arms to move the clip between the open configuration and the closed configuration, a distal end of the elongated flexible member characterized in that it includes a bushing (<NUM>) including a first ramped portion (<NUM>) tapering to a distal end of the bushing and a necked portion (<NUM>) extending proximally from the first ramped portion, a proximal end of the first ramped portion including a lip (<NUM>) defined via a recess extending between an interior surface of the first ramped portion and an exterior surface of the necked portion, wherein the connecting elements are configured to be crimped over the lip and the lip is configured to engage the hook when the connecting elements are crimped thereover.