There has been growing interest in the development of bipolar knives in therapeutic endoscopy due to their safety profile. These devices incorporate a negative electrode at the tip, ensuring closed-circuit current transmission. Thus, they have the potential to reduce transmural thermal injury, lowering the risk of perforation or stricture, as well as decreasing interference with implanted cardiac devices. However, reports describe lower cutting efficiency, with longer procedure times. We want to test the efficacy and safety of a new bipolar knife in a clinical setting.

Patients were prospective enrolled.  In all,  a newly certified bipolar knife wa used, with a 1.4-mm ball-type device and cap. A dedicated electrosurgical unit was utilized (Hangzhou AGS MedTech Co, China).

Twenty-six patients were included, with a median age of 69,5 (IQR 61,0-77,5) years, inwhom 28 procedures were performed: 16 gastric endoscopic submucosal dissections(ESD), 4 colonic ESD, 3 rectal ESD, 3 esophageal ESD and 2 peroral endoscopic myotomies. The median procedure time was 70 minutes (IQR 40-121). Regarding the 26 endoscopic resections, 24 were en bloc, of which 20 were curative. The median size of lesions was 25,0 mm (range 10–104mm). Two ESDs were converted to a hybridtechnique, one due to device malfunction. Only one major adverse event occurred (post-ESD rectal bleeding in a patient on dual antiplatelet therapy), which was endoscopically treated. No post-ESD strictures were observed, including in lesions on the cardia and rectum with significant luminal circumference involvement.

This new bipolar knife seems to be safe and effective in advanced endoscopic therapies, with potential to reduce the risk of perforation or stricture. Bipolar knives may play an important role in the future of third-space endoscopy, particularly in high-risk patients,although further comparative studies are needed to confirm our findings.