Digestive Endoscopy最新文献

Endoscopic cricopharyngeal myotomy (C-POEM) is an evolving, minimally invasive technique for treating cricopharyngeal dysfunction [1, 2], which may result from conditions such as idiopathic cricopharyngeal bar, Parkinson's Disease, or Inclusion Body Myositis. The procedure is technically challenging due to the confined space of the hypopharynx (Figure 1). Traditionally, C-POEM is performed using a standard gastroscope, which has a 9.9 mm outer diameter and a 2.3 mm working channel. With the addition of a conical distal attachment cap, a mucosal incision of approximately 15 mm is typically required to access the submucosal space, further complicating the procedure in anatomically restricted areas. We present a video case demonstrating the use of a next-generation slim therapeutic gastroscope—the Fujifilm EG-840TP—in a successful C-POEM. This scope introduces several important technical improvements: Slimmer outer diameter: 7.9 mm versus 9.9 mm (standard scope), allowing easier maneuverability in the hypopharynx and proximal esophagus; larger working channel: 3.2 mm versus 2.3 mm, enabling the simultaneous use of instruments and suction; smaller mucosal incision required: A 10 mm mucosal incision is sufficient, even with the distal cap in place; and enhanced tip angulation of 210° upward and 160° downward flexion, improving access and precision in tight anatomical spaces (Figure 2). These design enhancements facilitate safer and more efficient dissection, improve procedural control, and reduce tissue trauma. A conical cap (DH-083ST—FujiFilm, Japan) with a 3.5 mm distal stiff section from the tip of the gastroscope and a 7 mm inner diameter of the distal end was also used for the C-POEM. Our case highlights the feasibility, safety, and therapeutic potential of the EG-840TP in upper esophageal interventions [3, 4], suggesting that it may set a new standard for C-POEM and similar endoscopic procedures in narrow anatomical regions.

Niroshan Muwanwella: conceptualization (lead), resources, writing – original draft (lead). Krish Ragunath: conceptualization (supporting), writing – review and editing.

Approval of the research protocol by an Institutional Reviewer Board: None.

Informed consent: Informed consent obtained from patient to publish de-identified endoscopic images and videos.

Registry and the registration no. of the study/trial: None.

Animal studies: None.

The authors declare no conflicts of interest. Prof Krish Ragunath is an Associate Editor of Digestive Endoscopy.

Endoscopic full-thickness resection (EFTR) has emerged as a preferred therapeutic modality for the treatment of submucosal tumors, including gastrointestinal stromal tumors [1]. Despite its growing use, post-EFTR closure remains technically challenging due to difficulties in approximating and securing the mucosal edges [2, 3]. These challenges often hinder effective closure and increase the risk of complications.

To overcome these limitations, we have developed a novel closure technique employing a dual-channel endoscope, designed to facilitate precise and efficient wound approximation. The two working channels of the endoscope (GIF-2TQ26OM) are designated as Channel A and Channel B, with titanium clips deployed through each referred to as A-clips and B-clips, respectively.

During the closure procedure, only a single A-clip is used throughout. This clip is employed to grasp and retract the mucosa (or mucosa with the muscularis propria) from one side of the defect, aligning it linearly with the opposing edge (Figure 1B). Once proper alignment is achieved, one or more B-clips are applied to approximate the bilateral mucosal edges and secure the closure (Figure 1C,E). The A-clip is then released and repositioned to repeat the process on the next section of the defect (Figure 1D). After completing the placement of B-clips, the A-clip performs the final approximation to complete the closure. Figure 2 is an illustration.

This technique has been successfully applied in clinical practice, as demonstrated in the accompanying video (Video S1), confirming its feasibility and effectiveness in real-world EFTR cases.

The dual-channel endoscopic technique offers multiple advantages: improved mucosal alignment, reduced clip span, shorter procedural time, and enhanced surgical precision. Collectively, these benefits contribute to increased procedural efficiency and potentially lower complication rates.

Geng Qin designed and performed the research, collected and analyzed the data. Geng Qin and Shiyu Du offered funding support. Guanyu Chen drafted and revised the manuscript.

The authors declare no conflicts of interest.