Endoscopic submucosal dissection and tunneling procedures using a novel all-in-one bipolar device

Abstract

Background and study aims Recent innovations in devices and techniques have revolutionized the field of endoscopic resection procedures. In this study, we evaluated the safety and feasibility of endoscopic submucosal dissection and tunneling procedures with a novel, multipurpose bipolar device. Patients and methods Data from consecutive patients who underwent per-oral endoscopic myotomy (POEM), submucosal tunneling endoscopic resection (STER), and endoscopic submucosal dissection (ESD) using a novel bipolar device (December 2019 to February 2020) were analyzed retrospectively. Procedure duration, technical success, and adverse events (AEs) were recorded. Results A total of 10 procedures were performed using the novel bipolar device during the study period. The procedures included POEM (n = 7), STER for esophageal sub-epithelial tumor (n = 1), ESD for rectal polyp (n = 1), and gastric neuroendocrine tumor (n = 1). POEM was successfully completed in all patients. In patients who underwent STER and ESD, en-bloc resection was achieved in all. Mean procedure time for submucosal tunneling procedures (POEM and STER) was 59.12 ± 31.12 minutes. The procedures were completed without the requirement for exchange of accessories in eight cases (80 %). There were no major AEs. Mild and moderate AEs occurred during POEM and included capno-peritoneum (n = 1), retroperitoneal CO2 (n = 1), and empyema (n = 1). Conclusion ESD and tunneling procedures can be safely performed without the need for exchange of accessories using a novel bipolar device. Randomized comparison with conventional knives isrequired to confirm the utility of this device.

New Kid on the Block: “Speedboat”

“…We have described the use of this device in our previous study and several video case reports. 4 5 6 7 In brief, the standard steps of ESD and tunneling endoscopic procedures remain the same ( Figs. 3 4 5 6 ).…”

“…8 11 12 More recently, submucosal tunneling procedures including POEM and STER have been successfully performed using Speedboat device. 4 5 6 7 13…”

“…4 6 The same authors evaluated the performance of Speedboat device in 10 patients who underwent ESD and submucosal tunneling procedures. 5 The procedures included POEM ( n = 7), STER for esophageal subepithelial tumor ( n = 1), ESD for rectal polyp ( n = 1), and gastric neuroendocrine tumor ( n = 1). All the procedures were successfully completed.…”

Breaking the Barrier in Endoscopy

“…36 A novel multipurpose bipolar device can help obviate the need for a change of accessories in third space endoscopy as shown in a series of 10 cases which included seven cases of achalasia. 37 POEM was also shown to be an effective and durable treatment for spastic esophageal motility disorders (Type III achalasia, Jackhammer esophagus, distal esophageal spasm-DES) with long term (5 years) success rate of 82.6%. Most cases of post POEM GERD have been shown to be mild and proton pump inhibitor (PPI) responsive.…”

Gastric peroral endoscopic myotomy using a novel bipolar blade and the navigational tunnel technique

“…A novel multimodal cutting/cautery device has been reported for endoscopic submucosal dissection (ESD) and esophageal peroral endoscopic myotomy. 1 , 2 , 3 This device has not been reported for G-POEM, in which the unique shape and design may enhance submucosal dissection. We used this device, along with the navigational tunnel technique, in 3 G-POEM patients, and a representative case is presented here.…”