Clin Endosc.  2020 Jul;53(4):443-451. 10.5946/ce.2019.214.

Determining the Safety and Effectiveness of Electrocautery Enhanced Scissors for Peroral Endoscopic Myotomy (with Video)

Affiliations
  • 1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Abstract

Background/Aims
Peroral endoscopic myotomy (POEM) has recently come to the forefront in the management of achalasia. We aimed to analyze the efficacy and safety of the use of electrocautery enhanced scissors (EES) for POEM.
Methods
This retrospective cohort study prospectively collected the data of all adult patients (aged ≥18 years) with normal foregut anatomy who underwent POEM using EES. The patients’ baseline characteristics and procedure details (time, tunnel length, myotomy length, depth, and location) were recorded. The primary outcome was clinical success (3-month post-procedure Eckardt score of ≤3). The secondary outcomes were technical success and adverse events. A paired Student’s t-test was performed.
Results
Fifteen patients were included in this study. The technical success rate of myotomy using EES was 100%. Fellows participated in the myotomy in all cases. The clinical success rate was 93.3% (14/15). The mean pre-Eckardt score was 5.4±2.5, while the mean post-Eckardt score was 1.3±1.3, which indicated a significant improvement (p≤0.0001). The most common treatment-related adverse events were post-procedure pain (4, 26.7%) and symptomatic reflux disease (4, 26.7%).
Conclusions
In the largest series to date on the use of EES in POEM, we demonstrated that this technique has both technical and clinical efficacy as well as an excellent safety profile.

Keyword

Achalasia; Electrocautery enhanced scissors; Hybrid knife; Peroral endoscopic myotomy

Figure

  • Fig. 1. Electrocautery enhanced scissors. (SB Knife Jr; Olympus America, Center Valley, PA, USA).

  • Fig. 2. Initial site of myotomy, approximately 2 cm distal to the mucosal entry site.

  • Fig. 3. Extension of myotomy. (A) Proximal extent of myotomy. Electrocautery enhanced scissors (EES) are selectively closed on the internal circular muscle layer prior to incision. (B) EES are used to continue step-by-step distally to perform internal circular myotomy. (C) Final appearance after the full extension of the myotomy.

  • Fig. 4. Mean and individual changes in total Eckardt scores pre- and postperoral endoscopic myotomy (POEM).

  • Fig. 5. Mean and individual changes in Eckardt scores for dysphagia subscore. POEM, peroral endoscopic myotomy.

  • Fig. 6. Mean and individual changes in Eckardt scores for regurgitation subscore. POEM, peroral endoscopic myotomy.

  • Fig. 7. Mean and individual changes in Eckardt scores for chest pain subscore. POEM, peroral endoscopic myotomy.

  • Fig. 8. Mean and individual changes in Eckardt scores for weight loss subscore. POEM, peroral endoscopic myotomy.


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