Cricopharyngeal Per Oral Endoscopic Myotomy (C‐POEM) With a Novel Therapeutic Gastroscope

Short abstract

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1. Brief Explanation

Endoscopic cricopharyngeal myotomy (C‐POEM) is an evolving, minimally invasive technique for treating cricopharyngeal dysfunction [1, 2], which may result from conditions such as idiopathic cricopharyngeal bar, Parkinson's Disease, or Inclusion Body Myositis. The procedure is technically challenging due to the confined space of the hypopharynx (Figure 1). Traditionally, C‐POEM is performed using a standard gastroscope, which has a 9.9 mm outer diameter and a 2.3 mm working channel. With the addition of a conical distal attachment cap, a mucosal incision of approximately 15 mm is typically required to access the submucosal space, further complicating the procedure in anatomically restricted areas. We present a video case demonstrating the use of a next‐generation slim therapeutic gastroscope—the Fujifilm EG‐840TP—in a successful C‐POEM. This scope introduces several important technical improvements: Slimmer outer diameter: 7.9 mm versus 9.9 mm (standard scope), allowing easier maneuverability in the hypopharynx and proximal esophagus; larger working channel: 3.2 mm versus 2.3 mm, enabling the simultaneous use of instruments and suction; smaller mucosal incision required: A 10 mm mucosal incision is sufficient, even with the distal cap in place; and enhanced tip angulation of 210° upward and 160° downward flexion, improving access and precision in tight anatomical spaces (Figure 2). These design enhancements facilitate safer and more efficient dissection, improve procedural control, and reduce tissue trauma. A conical cap (DH‐083ST—FujiFilm, Japan) with a 3.5 mm distal stiff section from the tip of the gastroscope and a 7 mm inner diameter of the distal end was also used for the C‐POEM. Our case highlights the feasibility, safety, and therapeutic potential of the EG‐840TP in upper esophageal interventions [3, 4], suggesting that it may set a new standard for C‐POEM and similar endoscopic procedures in narrow anatomical regions.

FIGURE 1.

Submucosal tunnel at the hypopharynx showing cricopharyngeal bar in the foreground.

FIGURE 2.

Fujifilm EG‐840TP scope bending capability, outer diameter, and channel diameter.

Author Contributions

Niroshan Muwanwella: conceptualization (lead), resources, writing – original draft (lead). Krish Ragunath: conceptualization (supporting), writing – review and editing.

Ethics Statement

Approval of the research protocol by an Institutional Reviewer Board: None.

Informed consent: Informed consent obtained from patient to publish de‐identified endoscopic images and videos.

Registry and the registration no. of the study/trial: None.

Animal studies: None.

Conflicts of Interest

The authors declare no conflicts of interest. Prof Krish Ragunath is an Associate Editor of Digestive Endoscopy.

Supporting information

Video S1