The case of an ESD of an LST-GM lesion of about 30 mm in size located in the sigmoid colon with the Creo Medical Speedboat RS2 device is presented.
Recently, Fujifilm has developed a traction system for ESD based on the laparoscopic concept and the TAMIS (Transanal Resection of Rectal Lesions Surgical Technique) method, called Tracmotion. It is not yet marketed in Europe (if it is in the USA). The system has a 3mm caliber traction forceps attached to a handle that is crimped to dual channel endoscopes (one of which must be larger than 3.7mm caliber). It allows movements of the forceps in the three dimensions of space (3D). This makes the ESD technique simpler, faster and safer. Fujifilm has developed in parallel a new model of therapeutic endoscope called EI-760-D/S with a 3.7mm channel and another 3.2mm accessory. It stands out for its 210º upward angulation that allows better maneuverability and access to difficult areas of the digestive tract.In this presentation by Dr. Hiroyuki Aihara published in the «endoscopy know» application with access from the Fujifilm website, the usefulness of this device is explained in detail. Free Link to presentation in Fujifilm Clinical Learning Center
Another case of POEM performed in our hospital. This is a type I achalasia in an 86-year-old man. A standard myotomy (10 cm in length) was performed. An Olympus Triangle tip-J type knife and the ERBE Precise sect mode were used. This configuration allows dissection and coagulation in a more efficient way in ESD and POEM techniques.
Excellent review on the physical principles of precise sect technology and its application in ESD and POEM by Dr. Torsten Beyna and Dr. Roberta Maselli. The precise sect mode regulates itself according to the impedance of the tissue, which in turn is related to the contact surface of the knive with it. Thus, for the precoagulation of medium-sized vessels (0.5-1.5 mm), it is necessary to expose a wide contact surface of the knive on the sides of the vessel (once it has been properly dissected) and press the coagulation pedal during 1-2 seconds. When the vessels are smaller and are not arterial, they can be coagulated with a wide contact surface of the scalpel, without pressing it and pressing the blue pedal for 1-2 seconds. link to website
Precoagulation of medium sized blood vessels (0.5-1 mm) can be achieved with the Precise sect mode through lower impedance. It is achieved by applying larger contact surfaces without pressing the vessel with continuous activation of the coagulation pedal for 1-2 seconds. This may allow ESD and POEM to be performed more safely, without bleeding and therefore more quickly. Link to website