A Clinical Analysis: Performing ESD and POEM Using Novel Settings


This year, Drs. Salmaan Jawaid, Mohamed O. Othman, and Tara Keihanian, completed a study to evaluate the feasibility and safety of performing endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) using novel settings generated with a specialized ESU platform.

In addition to evaluating technical success, the physicians aimed to document procedure times and rate of en bloc/ R0 resection.

While many electrosurgical units on the market are currently being used for ESD, few were specifically designed for ESD and even fewer validated for it. 

When working within specialized areas like the digestive tract, the physician may prefer a tissue effect that varies from that needed for other endoscopic procedures, like sphincterotomy or mucosal resection.

Questions exist around the impact of a non-specialized energy current and how it might affect these sensitive tissues. “There are even suggestions that certain electrocautery settings may be implicated in short term complications, such as post-ESD esophageal stricture,” note the authors in their publication.1

The primary outcome of successful completion, defined as en bloc removal of the polyp via specialized settings, was achieved in 90% of ESD cases and 100% of POEM – numbers within alignment of clinical acceptability based on previous data.1

Additionally, key quality metrics, such as R0 resection and curative resection rates and dissection speed met or exceeded established ESD standards. A RO resection rate of 77.1% and a curative resection rate of 70.8% were documented in the ESD procedures. In the colon and duodenum, the en bloc/R0 resection rates were 87%/72.7% and 71.4%/33.3%, respectively.1 ACCESS THE STUDY HERE

“Dissection using this novel ESU, when compared to other ESU, allows for a more uniform and smooth dissection despite the variability in tissue composition,” the authors noted.

During procedures requiring dissection in the duodenum or colon, the ability to adjust watt to compensate for concern of inadvertent thermal damage to the MP was an area of particular interest.

“There is still no consensus for optimal electrocautery settings for ESD using current ESU systems…thus, newer ESUs specifically dedicated toward precise dissection of various gastrointestinal tissue are needed.”1

In a specialty where advanced therapies are evolving quickly, it is encouraging that the authors were able to conclude that CONMED's novel energy platform “can be added to the armamentarium of ESD capable generators,” further enabling surgical specimen retrieval to be completed under less invasive methods.

If you’re looking to elevate your practice with specialized electrosurgical technology, consider our latest platform: Beamer AVEO™.

1 Jawaid, S., Keihanian, T., Khalaf, M., Riojas-Barrett, M., Abdeljaber, W. Mercado, M., Zabad, N., Othman, M. (2023). Settings of a novel electrosurgical generator to enable efficient and safe submucosal endoscopic procedures. Endoscopy International Open, 11(08), E743-E751. https://doi.org/10.1055/a-2085-3757