SSAT - SPEEDBOAT VS. TRIANGLE TIP KNIFE IN GASTRIC PER-ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM) FOR GASTROPARESIS: A COMPARATIVE ASSESSMENT OF TECHNICAL PERFORMANCE, PERIOPERATIVE OUTCOMES, AND CLINICAL RESULTS

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SPEEDBOAT VS. TRIANGLE TIP KNIFE IN GASTRIC PER-ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM) FOR GASTROPARESIS: A COMPARATIVE ASSESSMENT OF TECHNICAL PERFORMANCE, PERIOPERATIVE OUTCOMES, AND CLINICAL RESULTS
Himsikhar Khataniar^*⁴, Sven Eriksson^1,3, Katherine Albus¹, Inanc Sarici^1,3, Ping Zheng¹, Shahin Ayazi^1,2,3
¹Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, PA; ²Department of Surgery, Drexel University, Philadelphia, PA; ³Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA; ⁴Department of Medicine, Allegheny Health Network, Pittsburgh, PA

Introduction
Gastric per-oral endoscopic pyloromyotomy (G-POEM) is an effective endoscopic pyloric drainage procedure for refractory gastroparesis, traditionally performed using the triangle tip knife (TTK). The speedboat knife (SBK) is a novel bipolar device that has an integrated needle, a unique design for radio frequency cutting and microwave coagulation, which limits need for device exchanges. Limited reports have demonstrated the feasibility of SBK for G-POEM; however, there is a paucity of data comparing SBK to traditional TTK. The aim of this study was to compare technical performance, perioperative outcome and clinal results of SBK to TTK.

Methods
Patients with medically refractory gastroparesis who underwent G-POEM with either TTK or SBK between 2019 and 2024 at our center were included. Outcome measures included technical success (defined as completion of pyloromyotomy without switching knives), operative time (minutes), perioperative complications, resolution of predominant gastroparesis symptoms, postoperative Gastroparesis Cardinal Symptom Index (GCSI) and improvement in gastric emptying scintigraphy results. Comparisons between SBK and TTK groups were evaluated to assess technical and intraoperative parameters, perioperative and postoperative outcomes.

Results
A total of 111 patients underwent G-POEM (SBK: 23; TTK: 88). The median (IQR) age was 53 (42-63), 80.2% were female, BMI was 28.4 (25-34) and gastroparesis etiology was 61% idiopathic, 27% diabetic and 12% post-surgical. Preoperative GCSI score was 3.1 (2-4). There were no differences between demographics, etiology or clinical presentation of gastroparesis (p>0.05).
Technical success was achieved in 22 (95.7%) SBK and 88 (100%) TTK G-POEMs (p=0.207). One procedure started with SBK and finished with TTK without issue. Operative times (p=0.261) and number of closure clips (p=0.668) were similar (Table 1). There were no leaks or perforations in either group. Length of stay was comparable between groups (p=0.373). Need for readmission within 30 days (p=1.000) and within 90 days (p=0.730) of surgery were also comparable.
At a mean (SD) of 13.4 (10) months after GPOEM there was no difference in the rate of predominant symptom resolution (p=1.000) or gastric emptying scintigraphy improvement (p=0.410). Postoperative GCSI scores (p=0.985) and the GSCI Nausea/Vomiting, Early Satiety and Bloating sub scores were also comparable (p>0.05). There was no difference in follow-up (p=0.303).

Conclusions
The speedboat knife is noninferior to the triangle tip knife for G-POEM, achieving comparable technical success, operative times and clinical outcomes. The speedboat knife is a viable alternative for endoscopic pyloromyotomy for patients with medically refractory gastroparesis.

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