It is already common knowledge that endoscopic procedures are responsible for the
production of large amounts of waste, mostly owing to the usage of a high number of
disposable instruments [1]. Gastric peroral endoscopic myotomy (G-POEM) is a well-known procedure used for
the treatment of refractory gastroparesis [2]. Like most submucosal endoscopic procedures, this technique requires the injection
of a premixed methylene blue/glycerol solution into the submucosa, in order to raise
a mucosal bleb and create the space to make a safe mucosal cut. This step is usually
performed with a routine single-use sclerotherapy needle [2]; however, a DualKnife could also be used for the same purpose, allowing the use
of one disposable injection needle to be spared.
We report the case of a 31-year-old patient who was suffering from refractory gastroparesis
secondary to diabetes mellitus type 1, who was referred to our center for G-POEM treatment.
After the ideal mucosal entry site had been identified, we opted to use the DualKnife
for the initial injection, as well as during the rest of the procedure ([Video 1]). This was easily performed without any extra inconvenience or difficulty during
the whole endoscopic intervention.
Video 1 A method to reduce the ecological impact of gastric peroral endoscopic myotomy by
performing the injection with the DualKnife, rather than with a sclerotherapy needle.
This case illustrates that, even if the DualKnife is shorter than the sclerotherapy
needle, it can have the same efficacy and performance for submucosal injection as
the latter. This approach has multiple advantages as it offers a time-saving during
submucosal endoscopy by eliminating an instrument change and, most importantly, it
leads to a significant reduction in waste production and the associated ecological
footprint of the procedure.
Endoscopy_UCTN_Code_TTT_1AU_2AF
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in gastroenterological endoscopy. All papers include a high quality video and all
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