Feasibility of Speedboat RS2 with bipolar radiofrequency energy for peroral endoscopic myotomy in patients with achalasia (with video)

Abstract

Background During peroral endoscopic myotomy (POEM), use of traditional instruments leads to an increase in overall time of procedure due to constant exchange of instruments. Speedboat-RS2 (Creo-Medical, UK) is a novel device which has shown promising results for endoscopic submucosal dissection of gastrointestinal lesions, but its feasibility, and safety for POEM is unexplored. Methods Data from patients who had undergone POEM for achalasia cardia utilizing Speedboat-RS2 was reviewed. Results Two patients with mean age of 46 years and mean symptom duration of 3 years were included. Both patients had type II achalasia diagnosed on esophageal manometry. One patient underwent anterior myotomy and the other posterior approach. Submucosal tunneling (~15 cm) was achieved in a mean of 20 minutes, myotomy (~ 9 cm) in 8 minutes and the entire procedure was completed in a mean of 30 minutes with 100 % technical success. Both patients were discharged the day after the procedure without any immediate adverse events. At 6 weeks, endoscopy was uneventful and the patients were asymptomatic. Conclusions Early experience shows that Speedboat-RS2 is feasible for performing POEM with good safety profile. Submucosal tunneling was relatively quick and coagulation was effective. Long term studies with a larger patient cohort are warranted.

Conflict of interest statement

Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1

aSpeedboat RS2 Endoscopic device with attached blade, insulated hull, and needle.bRetractable integrated needle being used for submucosal injection.cInstillation of saline underneath mucosa.dAn incision being made on posterior wall of the esophagus.eSubmucosal tunnel being created using Speedboat-RS2.fLateral and forward cutting of circular and longitudinal muscle fibers of the esophagus using the curved tip and flat edges of the blade.gLateral and forward cutting of circular and longitudinal muscle fibers of the esophagus using the curved tip and flat edges of the blade.hLateral and forward cutting of circular and longitudinal muscle fibers of the esophagus using the curved tip and flat edges of the blade.iMucosal incision closed with standard hemoclips.