Efficacy and Safety of Endoscopic Submucosal Dissection (ESD) with Bipolar Knife: A Single-Center Experience

Aims Endoscopic submucosal dissection (ESD) is a consolidated treatment for early-stage gastrointestinal cancer. However, it is a technically demanding procedure and associated with potential complications. Compared to conventional knives, which are based on monopolar current, the novel bipolar knives may reduce technical difficulty, procedure time, and complications related to electrosurgical thermal injury. Currently, no large-scale data are available to evaluate the efficacy and safety of this device. The primary aim of this study is to conduct a descriptive analysis of ESD performed with bipolar knives (Speedboat, Creo Medical SL) at a reference hospital. The secondary aim is to analyze the learning curve associated with this device.

Methods Data were obtained from a prospective registry maintained by the Resection Group of the Spanish Society of Digestive Endoscopy (SEED). Consecutive ESD cases performed by two expert endoscopists specializing in colorectal and gastric ESD, using bipolar knives (Speedboat inject 10fr[version1], inject 8fr[version2], and Ultraslim[version3], Creo Medical SL) at HUPH between July 2019 and May 2024 were identified. Patients were chronologically grouped, comparing the outcomes between case 1-10 (Group 1) and case 26-35 (Group 2). Technical success was defined as the completion of the procedure without the need to switch to a conventional knife [1] [2] [3] [4].

Results A total of 35 ESD cases utilizing the bipolar knife were included, with 54% of the patients being male and a mean age of 70 years. Most patients were classified as ASA I-II (80%). The rectum was the most common tumor location (69%), with a mean tumor size of 48 mm. All intra-procedural complications, including perforation and hemorrhage, were successfully managed endoscopically. Three patients experienced delayed bleeding and were effectively treated through endoscopic therapies. No cases of post-electrocoagulation syndrome or delayed perforation were reported. Comparative analysis between Group 1 and Group 2 revealed a statistically significant reduction in procedure time. Although Group 2 showed higher rates of technical success, complete resection, and R0 resection, these differences did not reach statistical significance, likely due to variability in the data attributable to the small sample size.

Conclusions The use of bipolar knives in ESD is effective and safe, with a reduction in the incidence of post-electrocoagulation syndrome and delayed perforation. However, larger-scale studies are needed to validate these findings.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 McCarty TR, Aihara H.. Endoscopic submucosal tunneling dissection: use of a novel bipolar radiofrequency and microwave-powered device for colorectal endoscopic submucosal dissection. VideoGIE 2020; 5 (8): 335-8
• 2 Tsiamoulos Z, Sibbons P, Morris S, Hancock C, Saunders B.. A novel multimodality endoscopic device for colonic submucosal dissection using a combination of bipolar radiofrequency and microwave modalities. Endoscopy 2016; 48 (3): 271-6
• 3 Nabi Z, Chavan R, Ramchandani M, Tsiamoulos Z, Basha J, Goud R. et al. Endoscopic submucosal dissection and tunneling procedures using a novel all-in-one bipolar device. Endosc Int Open 2020; 08 (10): E1302-7
• 4 Tsiamoulos ZP, Sebastian J, Bagla N, Hancock C, Saunders BP.. A new approach to endoscopic submucosal tunneling dissection: the “Speedboat-RS2” device. Endoscopy 2019; 51 (7): E185-6