Novel triangle tip‐jet knife increases efficiency in peroral endoscopic myotomy for achalasia

Abstract

Background and Aim Peroral endoscopic myotomy (POEM) is performed globally for the treatment of achalasia. A newly available endoscopic knife, the triangle tip‐jet (TTJ) (Olympus Triangle TipKnife‐J, KD‐645L), has the capability of knife dissection along with submucosal injection. We aim to present our experience with the TTJ knife in comparison to the conventional TT knife in POEM, with a focus on procedural characteristics including time, efficiency, and the number of instrument exchanges. Methods All patients with achalasia who underwent POEM between March 2016 and March 2020 at a single tertiary academic center were included in the retrospective cohort. Demographic, procedural, and outcomes data were compared. Results Ninety‐two procedures, 48 using the TT knife, and 44 with the TTJ knife were analyzed. Demographic data were similar. Procedure time was reduced using the TTJ knife (87 vs 61 min, P = <0.001) despite similar myotomy lengths (16.5 vs 15.2 cm, P = 0.09). Efficiency was increased in the TTJ group (5.5 vs 4.3 min/cm of procedure, P = 0.005). The number of instrument exchanges (16.7–1.7, P = <0.001) and usage of coagulation forceps decreased (1.7–0.5, P = <0.001). There was no difference in the procedural difficulty (POEM difficulty score [PDS] 2.2 vs 2.4, P = 0.4). Patients with higher procedural difficulty saw a greater improvement in procedural outcomes. Procedural success was high in both groups (96% vs 100%, P = 0.2). No serious adverse events were reported. Conclusions The use of the TTJ knife increases efficiency during POEM for Achalasia. The total procedure time is decreased by 28–41%, and procedural efficiency is increased by 22–34%.

Water-jet vs traditional triangular tip knife in peroral endoscopic myotomy for esophageal dysmotility: A systemic review and meta-analysis

“…We reviewed these and excluded 52 studies based on titles and abstracts and reviewed full texts of remaining 9 studies. Finally, 7 studies met our inclusion and exclusion criteria[ 9 , 17 - 21 ]. This consisted of 2 randomised controlled trial (RCT) and 5 retrospective single center cohorts published between 2012 and 2021.…”

Triangle-tip jet knife with hood attachment: novel modification to endoscopic knife

“…Recently, a novel versatile knife (TriangleTipKnife J; Olympus, Tokyo, Japan) has become commercially available and is used especially in endoscopic submucosal dissection and peroral endoscopic myotomy. 1 , 2 , 3 The TriangleTipKnife J (TTJ knife) is an endo-knife with a water supply function ( Fig. 1 ).…”