Outcome of peroral endoscopic myotomy in achalasia cardia: Experience with a new triangular knife

Abstract

Background and Aim:Peroral endoscopic myotomy (POEM) is a technically demanding procedure. Recently, a new triangular knife with integrated water jet function (TTJ) has been introduced. The present study was aimed to analyze and compare the operating time, efficacy, and adverse events (AEs) between the conventional (TT knife) and new knife (TTJ).Patients and Methods:All patients with achalasia cardia (AC) who underwent POEM between August 2015 and November 2016 were analyzed retrospectively. Operating time (OT), technical success, and AEs were assessed and compared between TT and TTJ knife.Results:A total of 193 patients with AC underwent POEM during the specified period. Both groups had equivalent number of different subtypes of AC (I, II, and III). There was no difference in technical success between the two groups (TT, 99% vs TT, 98.9%). OT was significantly less in the TTJ group as compared to TT group (53.8 ± 15.2 vs 66.26 ± 19.2; P = 0.0001). On subanalysis, OT taken for submucosal tunneling was significantly less with TTJ knife (34.6 ± 10.1 vs 45.83 ± 14.80), whereas OT was similar for myotomy and clipping in both the groups. Significantly fewer use of coagulation forceps and exchanges of accessories were required in TTJ knife group (2.92 ± 1.77 vs 10.5 ± 3.58; P = 0.0001). There were no major AEs. Minor AEs were noted in 21.5% and 31% of patients in TTJ and TT knife groups, respectively.Conclusion:New triangular knife reduces procedure time and technical difficulty with POEM. POEM is an efficacious treatment for achalasia and can be safely executed in an endoscopy unit.

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

“…These are complex therapeutic endoscopic procedures and carry a risk of collateral damage to the muscle or mucosa, especially when performed during the learning curve [12]. The technical difficulty associated with these procedures can be reduced with experience as well as through improvement in the currently available electrosurgical knives [4,7,13].…”

“…Recent innovations involving the technique as well as the devices used for tissue dissection have reduced the complexity associated with these advanced endoscopic procedures. In this regard, incorporation of water jet facility in newer electrosurgical knives has allowed endoscopistS to accomplish the procedure with less need to change the accessories 6 7 8 . However, exchange of accessories is still required for initial submucosal lifting injection and coagulation of larger vessels.…”

Endoscopic treatment of Zenker’s diverticulum using a new triangle tip knife

“…In the current series, we described the use of one such knife, a triangle tip knife with a water jet. The authors had previous experience with the TTJ knife for peroral endoscopic myotomy [3,8].…”

“…A new electrosurgical knife was used for cricopharyngeal myotomy: the TTJ knife (Triangle Tip Knife J, KD-645L, Olympus, Japan). We have previously described the use of this knife for peroral endoscopic myotomy [3]. The TTJ knife has a triangle tip with a length and thickness of 0.4 mm and 0.3 mm, respectively.…”

Peroral endoscopic myotomy using tailored accessories

“…explored outcomes of POEM performed using the newly available triangular tip knife with water jet function (TTJ) ( n = 93) as compared to the conventional TT knife ( n = 100) in 193 patients with achalasia. [ 7 ] Baseline patient and procedural characteristics were similar between both groups. As expected, rates of technical success (TT-99% vs TTJ-98.9%) and clinical success (TT-98% vs TTJ 97.8%) were achieved in a majority of patients and were similar between the TTJ and TT groups.…”