S5309 Novel Mucosal Elevation Device Minimizes CO2 Insufflation-Related Complications in EPOM: A Case Series

Introduction: Endoscopic peroral myotomy (EPOM) is a minimally invasive procedure for treating esophageal motility disorders, including achalasia. During submucosal tunneling, CO2 insufflation is used to create working space and enhance visualization. However, excessive insufflation can lead to complications such as pneumoperitoneum, subcutaneous emphysema, mediastinal emphysema, and, in rare cases, gas embolism. A novel device, consisting of a medical-grade plastic stick attached to the endoscopic cap, was developed to mechanically elevate the mucosa during tunnel creation. This approach minimizes reliance on CO2 insufflation, reducing the risk of related complications while maintaining adequate visualization. Case Description: Two patients underwent EPOM using the novel mucosal elevation device. The first case involved a 45-year-old man with achalasia type II, and the second case involved a 67-year-old man with achalasia type III. The device successfully elevated the mucosa during submucosal tunnel creation, allowing the procedure to be performed with minimal CO2 insufflation. Neither patient required decompression during or after the procedure. Both procedures were completed successfully without intraoperative or postoperative complications. Postoperatively, both patients reported minimal discomfort, and follow-up showed significant symptom improvement. Discussion: This innovative device demonstrates potential to improve the safety and efficiency of EPOM by reducing CO2 insufflation requirements. Mechanical mucosal elevation decreases the risks of insufflation-related complications, such as pneumoperitoneum, mediastinal emphysema, and rare but serious gas embolism. The device also ensures effective visualization and procedural control, which are critical for successful submucosal tunneling. These cases highlight the feasibility of incorporating this device into EPOM procedures. Further studies with larger cohorts are needed to validate these findings, evaluate long-term outcomes, and assess the device’s utility in other endoscopic applications. This novel device could represent a significant step forward in enhancing safety and reducing complications in EPOM.