Post written by Zaheer Nabi, MD, DNB, from the Asian Institute of Gastroenterology, Hyderabad, India.

In this video, we demonstrated the use of a new bipolar knife for peroral endoscopic myotomy (POEM) in a case with previous Heller’s myotomy. This knife uses radiofrequency energy for dissection and microwave energy for coagulation. The technique of POEM with the new knife has been illustrated in the accompanied video.

The video emphasizes 2 points: first, POEM is a safe and effective in cases with recurrent symptoms after prior Heller’s myotomy; second, POEM can be safely performed using a new bipolar knife.

Improvisations in devices and techniques is crucial for continued advancements in the field of therapeutic techniques. This video highlights the technical ease of POEM with a new “all in one” knife. This knife is boat shaped and has insulated upper surface and a protective hull at the bottom. This feature of the knife helps in preventing inadvertent mucosal or muscle injury. The knife is equipped with an integrated injection needle making it a wholesome device which in turn reduces the requirement of exchange of accessories.

POEM procedure can be performed using a number of different knives available commercially. The majority of the knives are monopolar, and there is a risk of mucosal injury in confined spaces like the gastroesophageal junction. Use of novel bipolar knives like the one demonstrated in the present video may reduce the likelihood of mucosal injuries. Besides POEM, this knife can also be utilized for endoscopic submucosal dissection and sub-mucosal tunneling endoscopic resection (STER). The use of this knife requires a separate electrosurgical generator and a channel diameter of at least 3.7 mm ie, therapeutic gastroscope.

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