After POEM (per-oral endoscopic myotomy) surgery, the clips used to close the incision site are designed to fall off on their own, typically within one to two weeks. They pass through your digestive tract and leave your body naturally in your stool, usually without you noticing. In most cases, you never need to think about them again.
Why Clips Are Used During POEM
POEM is a minimally invasive procedure performed through the mouth to treat swallowing disorders like achalasia. During the procedure, an endoscope is passed down the esophagus, and a small incision is made in the inner lining (the mucosa) to access and cut tight muscle fibers underneath. Once the muscle work is done, that mucosal entry point needs to be sealed shut. Endoscopic clips, small metallic clasps applied through the endoscope, pinch the edges of the incision together so the tissue can heal.
These clips are tiny, made from metals like titanium, stainless steel, or tantalum, and they grip the tissue much like a staple holds paper. They do not need to stay permanently. Their only job is to hold the incision closed long enough for healing to begin.
How and When Clips Detach
As the tissue underneath heals and regenerates, the clips gradually lose their grip on the mucosal surface. Most endoscopic clips detach within one to two weeks after placement. Once they release, they simply travel through the stomach and intestines and are passed during a normal bowel movement. They are small enough that you will not feel them pass.
That said, clips do not always follow the expected timeline. Research has shown that some clips remain attached far longer than anticipated, with retention documented for up to 33 weeks in certain cases. This is not necessarily dangerous, but it has changed how doctors think about clip behavior after endoscopic procedures. If your doctor schedules a follow-up endoscopy weeks or months after your POEM, they may check whether any clips are still in place and remove them if needed.
Clips and MRI Scans
One of the most common practical concerns after POEM is whether you can safely have an MRI while clips are still inside your body. The answer depends on the specific clip model your doctor used, and it is worth knowing the details.
Endoscopic clips are generally made from nonferromagnetic metals, meaning they are not strongly attracted to magnets. For years, this led to the assumption that MRI was perfectly safe for patients with these clips. However, some clip models have shown unexpected movement under magnetic fields as low as 1.5 Tesla (the standard strength for most clinical MRI machines). No actual MRI-related complications from gastrointestinal endoscopic clips have been reported in the medical literature, but the theoretical risk has prompted caution.
The U.S. Food and Drug Administration classifies implanted devices into three MRI categories: safe, conditional, and unsafe. Some popular clip models, like the QuickClip and LongClip, are labeled MRI unsafe by their manufacturers. Others, like the Resolution Clip, carry an MRI conditional label, meaning an MRI can be done but only under specific conditions outlined by the manufacturer. In practice, many radiology departments will ask you to wait at least six weeks after your procedure before scheduling an MRI, giving the clips time to detach and pass naturally. If you need an urgent MRI sooner than that, let the radiology team know about your recent POEM so they can assess the situation.
What If Clips Stay Too Long
Retained clips rarely cause symptoms. Most people with clips that linger beyond the expected window have no idea they are still there. In some cases, a retained clip is discovered incidentally during a follow-up endoscopy or imaging for another reason. If a clip is still attached and needs to come out, your doctor can remove it during a routine endoscopy using a grasping tool passed through the scope. This is a straightforward addition to an already planned procedure and does not require separate surgery.
Occasionally, a retained clip can cause minor irritation at the attachment site or interfere with interpretation of imaging studies. But significant complications from clips that stick around longer than expected are uncommon. The main reason doctors pay attention to clip retention is the MRI safety question described above: if you need an MRI and your clips have not yet passed, it creates a scheduling consideration that would not exist otherwise.
What You Should Keep Track Of
After your POEM procedure, ask your surgical team which clip model was used. This is especially important if you anticipate needing an MRI in the weeks or months following surgery. Having the clip name on hand lets the radiology department quickly determine whether scanning is safe or whether waiting is the better option.
You do not need to watch for the clips in your stool or try to confirm they have passed. There is no reliable way to do this at home, and it is not medically necessary. Your follow-up appointments after POEM will typically include an assessment of how the incision site has healed, and your doctor can check on clip status at that time if there is any reason to do so.