Guide to endoscope selection for peroral endoscopic myotomy procedures.

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Peroral endoscopic myotomy (POEM) is a standard treatment for achalasia.
• Limited guidance exists on optimal endoscope selection for POEM procedures.
• Prior studies focused on POEM technique, electrosurgical settings, and accessories.

Purpose of the Study:

• To review and compare commonly used endoscopes for POEM.
• To highlight key characteristics, advantages, and limitations of different endoscopes.
• To provide guidance on endoscope selection for POEM.

Main Methods:

• Comparative review of endoscopes from three major vendors.
• Evaluation based on distal outer diameter (OD), accessory channel size and position, working length, tip angulation, and ergonomics.
• Analysis of suction capacity based on accessory channel size.

Main Results:

• Endoscopes with 3.2-mm accessory channels show superior suction capacity compared to 2.8-mm channels.
• Slim pediatric colonoscopes offer high maneuverability with a 3.2-mm channel.
• Newer diagnostic endoscopes with 7.9-mm OD and 3.2-mm channels provide enhanced suction and tip control.

Conclusions:

• Various endoscopes are suitable for POEM, each with trade-offs.
• Slim colonoscopes provide maneuverability but may limit device compatibility.
• Diagnostic scopes with 3.2-mm channels offer improved function and flexibility, potentially becoming a future standard for third-space endoscopy.