Speedboat™ is a novel multimodal endosurgical device.  It utilizes the use of advanced bipolar energy for cutting/dissection and super-high frequency microwave energy for coagulation. This study aims to evaluate the efficacy of two versions (‘Inject’ with needle  and ‘Ultraslim’ which is needless) of Speedboat assisted Endoscopic Submucosal Dissection (S-ESD) in the management of complex colorectal polyps.

Data, from a prospectively collected clinical audit (2018-2025) was analyzed. Up to 02/2023 Speedboat “Inject” device was used for S-ESD cases whereas since 03/2023 the new iterative version, Speedboat “Ultraslim” device, was introduced. Cases were divided into two groups, the Inject group (01/2018-02/2023), and Ultraslim group (03/2023-11/2025). Lesions’ characteristics, location, long and short axis length, lesion surface (cm²), time and speed of dissection (cm²/h) were compared between the groups. 

Over the study period, a total of 411 consecutive patients had an S-ESD attempt. 30 cases (7.3%) were abandoned, 25 converted to pEMR (6.1%). 356 en-bloc resections achieved [en-bloc rate 93.4%, 56.2% male, mean age 72] with a mean surface of 19.11cm², and dissection speed 12.2 cm2/hr.

In the Inject group 200 cases were attempted in total. 21 were abandoned (10.5%) and 14 converted to pEMR (7%). 165 en-bloc resections were achieved [en-bloc rate 92.2%, 56.6% male, age 72 years with mean surface of 18.3 cm², and speed 9.98 cm²/h.  102 patients had their procedure under GA (62%) to remove 142 distal (86%) and 24 proximal (14.5%) lesions which after histopathological examination revealed 38 polyps with HGD (23%) and 22 with cancer (13.3%).

In the Ultraslim group 211 cases were attempted in total. 9 cases were abandoned (4.3%) and 11 converted to pEMR (5.6%). 191 en-bloc resections were achieved  [en-bloc rate 94.6%, 55.7% male, age 71 years, mean surface 21.78 cm2 and speed 15.54 cm2/h. 175 patients were done under GA (91.6%), 149 distal (78%) and 34 proximal colon lesions (18%) were excised. 51 cases showed HGD (27%) and 25 were malignant (13.1%).

There was a significant difference between the two groups in dissection speed (p=<0.001), and GA procedures (p<0.001). Borderline statistical significance was seen in the mean surface (p=0.07) in addition to percentage of abandoned cases (p=0.015). No statistically significant difference in regards with age, gender and location was found between the groups.

The use of Ultraslim needless device assisted S-ESD and GA appears to facilitate faster excision of large, complex colonic lesions and reduced number of abandoned cases. Data from an international registry will aid in further understanding of confounding factors for dissection speed.