Use of triangle tip-jet knife for peroral endoscopic myotomy effective in patients with achalasia

This modification involved adapting the TTJ with a disposable clip sheath, termed TTJ with hood attachment (TTJ-H). The study aimed to compare the safety and efficacy of TTJ and TTJ-H in POEM treatments. The retrospective cohort study, using a 1:1 propensity score matching, delved into several key parameters among 196 patients who underwent POEM between January 2021 and June 2023. The comparison between TTJ and TTJ-H revealed notable findings:

• Procedure time reduction: TTJ-H exhibited a significant decrease in the mean procedure time from 93.5 to 80.2 minutes, marking a notable 14% reduction (P = 0.012).

• Enhanced myotomy efficiency: The use of TTJ-H improved myotomy efficiency substantially, displaying a 16% increase from 2.76 to 2.32 minutes per centimeter (P < 0.001).

• Reduced coagulation forceps usage: TTJ-H demonstrated a remarkable reduction in coagulation forceps usage for hemostasis, dropping from 3.87 to 0.55, showcasing an impressive 86% decrease (P < 0.001).

Overall, the study findings suggest that incorporating the TTJ-H modification into POEM procedures can yield several advantages, including reduced procedure time, improved myotomy efficiency, and decreased reliance on coagulation forceps. These enhancements not only contribute to procedural streamlining but also potentially reduce overall costs associated with the treatment.

This innovative adaptation offers promise in optimizing the efficacy and safety of endoscopic surgeries for esophageal motility disorders. The potential to minimize procedure duration and enhance precision holds substantial implications for patients undergoing these interventions.

Reference:

Kimoto, Y., Inoue, H., Shimamura, Y., Azuma, D., Ushikubo, K., Yamamoto, K., Okada, H., Nishikawa, Y., Tanaka, I., Jandee, S., Navarro, M. J., & Onimaru, M. Hood attached vs conventional triangular tip-jet knife in peroral endoscopic myotomy: a propensity score matching cohort study. Gastrointestinal Endoscopy,2023. https://doi.org/10.1016/j.gie.2023.12.001