Feasibility of a novel slim gastroscope for endoscopic submucosal dissection: A case series (with video).

Endoscopic submucosal dissection has transformed early-stage gastrointestinal tumor treatment. This series showcases a novel slim gastroscope's efficacy in tackling challenging lesions. Retrospective analysis of 17 patients undergoing endoscopic submucosal dissection using the novel slim gastroscope for pharyngeal, esophageal, gastric, duodenal, and rectal lesions at our tertiary care center between November 2022 and July 2023. The slim scope has an outer diameter of 7.9 mm, an accessory channel diameter of 3.2 mm, and a downward bending angle of 160 degrees. Primary outcomes were en-bloc and R0 resection rate and secondary outcomes were procedure time, adverse events, and specimen/defect size. 100% successful en bloc and R0 resections were achieved with no significant adverse events. The median lesion size was 15 mm (2-40 mm), and the median procedure time was 30 min (5-105 min). Various strategies, including multiple tunnels, pocket creation,​ and endoscopic intermuscular dissection, were employed. The novel slim gastroscope is feasible for endoscopic submucosal dissection in many locations including the pharynx and duodenum and in certain complex lesions (large gastric lesions, rectal lesions with deep submucosal invasion, and circumferential esophageal lesions). This warrants further investigation through larger comparative studies to validate its efficacy and safety in a broader patient population.