Peroral endoscopic myotomy using FlushKnife BT: a single-center series

Tanaka, Shinwa; Toyonaga, Takashi; Kawara, Fumiaki; Grimm, Ian S.; Hoshi, Namiko; Abe, Hirofumi; Ohara, Yoshiko; Morita, Yoshinori; Umegaki, Eiji; Azuma, Takeshi

doi:10.1055/s-0043-111721

Cited by 11 publications

(12 citation statements)

References 28 publications

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“…While the judgment is not well founded for the reason that outcome evaluation from short-time follow-up was not enough for chronic disease like DES. In this case, symptoms, especially dysphagia and chest pain, were both improved after POEM, which was consistent with previous reports [17][18][19][20]. Further, the excellent long-time efficacy was also observed during the 2.5-year follow-up.…”

Section: Discussionsupporting

confidence: 91%

Long-term outcomes of per-oral endoscopic myotomy in a patient with distal esophageal spasm followed up for 2.5 years: two sides of the same coin – A Case Report and Literature Review

et al. 2019

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Introduction Distal esophageal spasm (DES), a relatively rare condition, is characterized by simultaneous contractions of the distal esophagus and manifested by dysphagia and chest pain. Several treatment options are recommended, such as pharmacological therapy, endoscopic interventions, and surgical myotomy. Recently, per-oral endoscopic myotomy (POEM) has been adopted as an effective and less-invasive treatment due to its excellent short-term clinical outcomes. Nevertheless, few reports describe its long-term effects. Case presentation A 65-year-old woman complained of chest pain accompanied with dysphagia and weight loss for 4 months. A series of examinations suggested that she was suffering from DES and then POEM was performed. During the 2.5-year follow-up, we observed an exciting long-term outcome. Interestingly, hematoxylin and eosin staining verified a large number of eosinophils in the muscularis externa, which was absent in the mucosa of the esophagus of the patient. Conclusions We herein report a case of DES who underwent POEM to eliminate persistent esophageal contractions. Eckardt score, esophageal emptying test, and high-resolution manometry were assumed to monitor the efficacy of POEM. During treatment and 2.5 years after operation, esophageal muscle biopsies and/or mucosal tissues were obtained. This case has been presented to describe that POEM could be a strategy for DES with a long-term curative effect and that eosinophils in the muscle layer of the esophagus might be involved in the pathogenesis of DES. What is more, we reviewed literature to find similar cases reported in the past.

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Section: Discussionsupporting

confidence: 91%

Long-term outcomes of per-oral endoscopic myotomy in a patient with distal esophageal spasm followed up for 2.5 years: two sides of the same coin – A Case Report and Literature Review

et al. 2019

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…[ 23 24 25 26 ] Evolution of new devices and techniques aim at reducing the technical difficulty with this procedure. [ 10 16 ] One of the markers of technical difficulty with an endoscopic procedure is OT which reduces after the completion of learning curve. [ 27 ]…”

Section: Discussionmentioning

confidence: 99%

“…This knife (FlushKnife BT, DK2618JB; Fujifilm, Tokyo, Japan) is also equipped with water jet, and therefore, reduces the exchanges of accessories. [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 13 14 ] In addition to these, the use of stag beetle knife and needle knife with spherical tip (FlushKnife BT, DK2618JB; Fujifilm, Tokyo, Japan) has also been described. [ 15 16 ] The difference in the choice of knife is mainly based on operator's preference. Recently, a new knife equipped with water jet function (TTJ knife) has been introduced.…”

Section: Introductionmentioning

confidence: 99%

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

Nabi¹,

Ramchandani²,

Chavan³

et al. 2018

Saudi J Gastroenterol

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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.

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Peroral endoscopic myotomy using FlushKnife BT: a single-center series

Cited by 11 publications

References 28 publications

Long-term outcomes of per-oral endoscopic myotomy in a patient with distal esophageal spasm followed up for 2.5 years: two sides of the same coin – A Case Report and Literature Review

Long-term outcomes of per-oral endoscopic myotomy in a patient with distal esophageal spasm followed up for 2.5 years: two sides of the same coin – A Case Report and Literature Review

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

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

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