To assess the efficacy and safety of a bipolar knife in POEM.

Single-center retrospective study including patients undergoing POEM between October 2023 and May 2025, using the Speedboat™ knife and the CROMA energy platform (Creo Medical, UK). Categorical variables were presented as frequencies and percentages. Continuous variables were summarized using median and interquartile range (IQR). To compare the pre- and post-POEM Eckardt scores we used the Wilcoxon signed-rank test for paired samples. The Speedboat knife has an insulating cover on one side that reduces the risk of accidental mucosal injury, is 1:1 rotatable, and incorporates a needle/injection channel. The CROMA platform provides bipolar radiofrequency cutting as well as microwave coagulation, making the use of a hemostatic forceps hardly necessary.

Seventy-five patients were included (median age 52 years, 61.3% male, 83.8% ASA I–II). Achalasia was the most frequent indication (86.6%). Forty-six point seven per cent had undergone previous treatment (29.3% with one technique and 17.3% with more than one technique). The median length of the submucosal tunnel was 11 cm (IQR 11–15). In most cases, the myotomy was posterior (89.3%) and full-thickness (97.3%), with a median length of 5 cm (IQR 5–8) in the esophagus and 2.5 cm (IQR 2–3) in the stomach. The location of the gastric myotomy was determined by visual inspection in 98.7% of cases. A total of 5 clips (IQR 4–5) were used for mucosotomy closure. Technical success was 100%, and clinical success (post-POEM Eckardt score ≤3) was 93.3% after 24 months follow-up (IQR 12–24). The median Eckardt score decreased from 6 (IQR 3–8) pre-POEM to 1 (IQR 0–2) post-POEM (p<0.0001). Proton pump inhibitors use increased from 34.7% pre-procedure to 75.7% after POEM. Complications occurred in 5 cases (6.7%): 1 inadvertent mucosotomy, 1 bleeding, 2 pneumonias, and 1 esophagopleural fistula. Median hospital stay was 3 days.

Performing POEM with a bipolar knife seems as effective and safe as using a monopolar knife and may provide additional theoretical advantages regarding the energy delivery (lower risk of peripheral tissue damage, no interference with implanted devices).