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Comparative evaluation of bipolar versus monopolar energy platforms in G-POEM for gastroparesis: technical
Inanc S Sarici1,2, Himsikhar Khataniar1,3, Jennifer M Kolb4
1Chevalier Jackson Esophageal Research Center, Western Pennsylvania Hospital, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA.
Background:
Gastric peroral endoscopic pyloromyotomy (G-POEM) is an established treatment for medically refractory gastroparesis, traditionally performed using monopolar electrosurgical platforms. A novel bipolar energy device integrates cutting and coagulation into a single instrument and may streamline submucosal tunneling procedures. While feasibility has been demonstrated, direct comparisons between bipolar and monopolar energy platforms are lacking. This study aimed to compare technical performance, learning curves, perioperative metrics, and clinical outcomes between these two platforms in G-POEM.
Methods:
Patients undergoing G-POEM using either a bipolar energy platform (Speedboat knife, SBK) or a monopolar energy platform (Triangle-tip knife, TTK) between 2019 and 2024 were retrospectively reviewed. Primary outcomes included technical success, operative time, and learning curve inflection points based on operative efficiency. Secondary outcomes included perioperative complications, symptom resolution, postoperative Gastroparesis Cardinal Symptom Index (GCSI) scores, and gastric emptying scintigraphy results.
Results:
A total of 111 patients were included (SBK: 23; TTK: 88). Baseline characteristics were similar between groups. Technical success was achieved in 95.7% of SBK and 100% of TTK cases (p = 0.207). One SBK case required conversion to TTK. Learning curve analysis showed inflection points at 7 procedures for SBK and 8 for TTK, based on operative time reduction (SBK: 98.0 vs 60.1 min, p = 0.001; TTK: 83.3 vs 63.1 min, p = 0.005). Median operative time, hospital stay, and 30- and 90-day readmission rates were comparable between groups (all p > 0.05). No leaks or perforations occurred. At a mean follow-up of 13.4 (10) months, there were no differences in predominant symptom resolution (p = 1.000), postoperative GCSI scores (p = 0.985), or GCSI subdomain scores (all p > 0.05). Improvement in gastric emptying scintigraphy was also similar (p = 0.410). Follow-up duration was comparable (p = 0.303).
Conclusion:
Bipolar energy platforms demonstrated comparable technical success, learning curves, and clinical outcomes to monopolar energy platforms for G-POEM. Bipolar energy may serve as a safe and effective alternative for endoscopic pyloromyotomy in patients with medically refractory gastroparesis.
