This study aimed to compare the SwiftCoag and PreciseSECT modes used during the submucosal dissection step of ESD. Primary outcomes included dissection speed, procedure duration, and use of hemostatic forceps. Secondary outcomes focused on safety through analysis of intra- and post-procedural complications, and pathological specimen quality based on clean margin status

We conducted a retrospective, single-center study at a tertiary University Referal Center. Patients were identified from a prospectively collected registry of ESD procedures performed between 2017 and 2024 using either the SwiftCoag or PreciseSECT electrosurgical modes for the submucosal dissection step of ESD. To ensure maximal standardization, only procedures performed with a Dual Knife-J and glycerol submucosal injection were included. Clinical, procedural, and histopathological data were extracted from electronic records and operative reports. Quantitative variables were analyzed using the Mann-Whitney U test, and qualitative variables with Fisher’s exact test. Statistical analyses were performed using Jamovi.

Based on the selection criteria, a total of 219 patients were included in the analysis. The study population was composed of 63% men and 37% women, with a median age of 68 (IQR 60.5-74) years. As for the electrosurgical mode used, 146 patients underwent ESD with SwiftCoag and 73 with PreciseSECT. Regarding the anatomical distribution of ESD procedures, 78 were performed in the esophagus (35.6%), 46 in the stomach (21.0%), 20 in the colon (9.1%), and 75 in the rectum (34.2%). No duodenal procedures were included in the study. There was no significant difference in the anatomical distribution of ESD procedures between the SwiftCoag and PreciseSECT groups.

Median procedure duration per ESD was significantly shorter with PreciseSECT (70 min [IQR: 50–90]) compared to SwiftCoag (90 min [IQR: 60–136]; p = 0.009). Dissection speed was significantly higher with PreciseSECT (21.2 mm²/min [IQR: 16.17–28.9]) than with SwiftCoag (13.5 mm²/min [IQR: 8.03–20.8]; p < 0.001). Use of hemostatic forceps was more frequent with SwiftCoag (69.9%) than with PreciseSECT (54.8%; p = 0.035), suggesting improved intraprocedural hemostasis with PreciseSECT.

No difference in muscular layer injuries or full-thickness perforations was observed between the SwiftCoag and PreciseSECT groups (p = 0.098), the rate of uneventful procedures tended to be higher with PreciseSECT (80,8%) than with SwiftCoag (69,9%), though not statistically significant.

Symptomatic esophageal strictures requiring balloon dilation occurring within 90 days after ESD, were observed in 11.5% of patients treated with PreciseSECT and 5.8% with SwiftCoag (p = 0.394), suggesting no significant difference in clinical stricture rates. This trend may be partly explained by a higher proportion of extensive resections exceeding 90% of the esophageal circumference in the PreciseSECT group (34.6% vs 9.6%).

Thirty days delayed post-procedural bleeding, was observed in colorectal procedures only. It affected 8.4% of patients overall, with a rate of 15.2% in the PreciseSECT group and 4.8% in the SwiftCoag group (p = 0.121).

Quality of the specimen was comparable between groups, as reflected by similar en bloc resection rate (93.2% with PreciseSECT; 95.2% with SwiftCoag, p = 0.540), clear vertical margin (VM0) rate (97.3% with PreciseSect vs 93.8% with SwiftCoag), p = 0.079), clear horizontal margin (HM0) rate (91.8% with PreciSect vs 88.4% with SwiftCoag, p = 0.626).

Oncologically, low-risk resections, based on ESGE recommendations, were similar in both groups (PreciseSECT (82.2%) ; SwiftCoag (78.1% ); p = 0.222).

PreciseSECT was associated with faster dissection and less use of hemostatic forceps, with similar en-bloc and margin-free rates compared to SwiftCoag. Our data support PreciseSECT as a facilitating and economical technical improvement of ESD.