Endoscopic submucosal tunneling dissection: use of a novel bipolar radiofrequency and microwave-powered device for colorectal endoscopic submucosal dissection

Novel devices for third-space endoscopy procedures

Third-space endoscopy (TSE) is a subspecialty in interventional endoscopy that exploits the submucosa as a working space for the management of various gastrointestinal diseases. Over recent years, TSE has emerged as a viable alternative to surgery for the treatment of various conditions. The rapid dissemination and adoption of TSE has been largely supported by the advent of novel devices aimed to improve the efficacy and safety of these procedures. In this article, we review some of the recent developments in TSE devices and provide our initial experience with these instruments in clinical practice.

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

Video 1Demonstration of gastric peroral endoscopic myotomy using a novel bipolar blade and the navigational tunnel technique.

New Kid on the Block: “Speedboat”

Innovations in devices and techniques have parallelly propelled the field of therapeutic endoscopy in gastrointestinal tract. With the development of endoscopic resection techniques and the availability of newly designed electrosurgical knives, the minimally invasive management of early gastrointestinal neoplasms has revolutionized. The currently available electrosurgical knives are monopolar devices, not equipped with injection needle and required to be exchanged with coagulation forceps for hemostasis. Monopolar electrosurgical devices require higher voltages with associated risks. A recent innovation in the field of endoscopic knives is a new device called “Speedboat” device, specially designed for use in endoscopic dissection procedures. This is a bipolar device that utilizes radio frequency energy for cutting and microwave energy for achieving hemostasis. Speedboat device possesses hemostasis capability and has an integrated injection needle that imparts an “all-in-one” quality to this device. Preliminary data suggest the safety and utility of this device in performing a variety of endoscopic dissection and resection procedures including endoscopic submucosal dissection, per-oral endoscopic myotomy, and resection of subepithelial tumors.

Endoscopic Management of Complex Colorectal Polyps: Current Insights and Future Trends

Most colorectal cancers arise from adenomatous polyps and sessile serrated lesions. Screening colonoscopy and therapeutic polypectomy can potentially reduce colorectal cancer burden by early detection and removal of these polyps, thus decreasing colorectal cancer incidence and mortality. Most endoscopists are skilled in detecting and removing the vast majority of polyps endoscopically during a routine colonoscopy. Polyps can be considered “complex” based on size, location, morphology, underlying scar tissue, which are not amenable to removal by conventional endoscopic polypectomy techniques. They are technically more challenging to resect and carry an increased risk of complications. Most of these polyps were used to be managed by surgical intervention in the past. Rapid advancement in endoscopic resection techniques has led to a decreasing role of surgery in managing these complex polyps. These endoscopic resection techniques do require an expert in the field and advanced equipment to perform the procedure. In this review, we discuss various advanced endoscopic techniques for the management of complex polyps.