LOW POWER FORCED COAGULATION OF LARGER VESSELS WITH ESD KNIFE REDUCES HEMOSTATIC FORCEPS USE DURING ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AND PERORAL ENDOSCOPIC MYOTOMY (POEM)

Aims Precoagulation of larger vessels is important in preventing bleeding and reducing operative time of third-space endoscopy procedures. Coagulation forceps is traditionally used for that purpose, requiring repeated device exchange. Precoagulation method using low power forced coagulation with ESD knife has been described by Japanese authors. Our study evaluated efficacy of 1-10 forced precoagulation during ESD and POEM procedures and its influence on coagulation forceps use.

Methods We prospectively included 28 consecutive patients that underwent ESD or POEM in our institution. Large vessels that normally require precoagulation with hemostatic forceps were selected for 1-10 knife precoagulation, except for very large vessels where this technique seemed unfeasible. Vessel was hooked from both directions with opened ESD knife (DualKnife, Olympus, Japan) and coagulated using forced coagulation effect 1, 10W on VIO200D electrosurgical unit (ERBE Elektromedizin, Germany). Successful vessel coagulation and cutting was recorded, as well as failures requiring a switch to coagulation forceps.

Results 17 patients undergoing ESD and 11 patients undergoing POEM were included, with 61 vessels attempted for 1-10 knife precoagulation. Success rate of 1-10 knife precoagulation was 92% (56/61). Only 5/61 vessels required a switch to coagulation forceps, due to bleeding. There was no difference in efficacy regarding procedure type (ESD vs. POEM, 91% vs 93%, p=1). Use of 1-10 knife precoagulation obliterated the need for coagulating forceps use completely in 11/28 patients (39%, 6/17 in ESD and 5/11 in POEM group).

Conclusions Vessel precoagulation with knife using 1-10 forced coagulation method is effective in reducing operational time and costs during ESD/POEM.

Publication History

Article published online:
14 April 2022