Coming Soon Bipolar Endoscopic Submucosal Dissection (ESD)

Bipolar ESD System

Name: Bipolar ESD System
Brand: AGS MedTech

Bipolar ESD: current runs from the knife tip to a return electrode on the scope tip; no grounding pad.

This page is intended for healthcare professionals.

4Bipolar modes on the AEU-120B: pure cut, blend cut, strong and soft coagulation

3Knife tip options: needle, hook, disc

0Grounding pad on the patient's body

AGS ESD cart: AEU-120B generator, UW600 irrigation pump and two foot pedals

Components

What is in the system?

Four parts close the bipolar circuit.

AEU-120B Generator

High-frequency generator on the ESD cart with the UW600 irrigation pump and foot pedals.

Single-Use Bipolar Knife

Needle, hook and disc tip variants; the disc tip grips the tissue for marking, hooking and cutting, and the end of the sheath also conducts (Chen 2022).

Distal Attachment with Return Electrode

Transparent cap on the endoscope tip that carries the return electrode; the circuit closes through the mucosa it touches.

Bipolar Coagulation Forceps

For coagulation and hemostasis in the digestive tract with high-frequency current (manufacturer indication); the picture shows the jaw variants.

What it is: AEU-120B generator, single-use bipolar knife, distal attachment with return electrode, bipolar coagulation forceps.
Who it is for: Early neoplasia of the esophagus, stomach and colorectum that meets your unit's ESD indications.
How it is used: Usual ESD steps: marking, submucosal injection, circumferential incision, dissection.
Generator: AEU-120B
Cart: Generator, UW600 irrigation pump and hanger on one cart
Knife: Single use, through the working channel; needle, hook and disc tip variants
Pump: UW600: compatible with Olympus, Fujifilm and Pentax endoscopes

Patient selection

Who is it for?

ESD removes early digestive tract cancers en bloc, but a monopolar knife drives the current vertically through the wall to a pad on the body. In the thin-walled esophagus and colorectum, that vertical heat is a known risk factor for perforation.

Earlier bipolar knives kept the current at the tip but cut slowly, so monopolar stayed the standard. The AGS knife moves the return electrode onto a cap at the scope tip; in the published porcine study cutting speed did not differ from the monopolar knife, and the authors attribute this to the larger contact area.

Early neoplasia of the esophagus, stomach or colorectum with an ESD indication in your unit
Thin-walled sites, esophagus and colorectum, where vertical thermal damage matters most
Teams already performing monopolar ESD: same steps, same endoscope, same generator settings in the study

Procedure

How is it performed?

The ESD sequence you already know; what changes is the circuit.

AEU-120B screen in bipolar mode, blend cut and soft coagulation; UW600 pump below

Step 01

Set the generator

You select the bipolar programme and connect the knife. In the published study auto-cut was 30 W and forced coagulation 60 W, the same settings as the monopolar arm; the cart's pump feeds the irrigation.

Distal attachment with the return electrode ring, seen from the front

Step 02

Mount the distal attachment

The cap goes on the endoscope tip and touches the mucosa. Keep the knife tip close to the cap and in view: the circuit closes through that contact.

Bipolar knife: the slider on the handle advances the tip, the side plug goes to the generator

Step 03

Mark, incise, dissect

Marking, submucosal injection, circumferential incision and dissection follow the usual ESD sequence. The disc tip marks, hooks and cuts; the same knife coagulates the small vessels as you go.

Bipolar coagulation forceps: three jaw variants on their insulated sheaths

Step 04

Control the bleeding

Larger vessels are grasped and coagulated with the bipolar forceps (manufacturer indication).

The difference

The current closes at the scope tip; in the porcine study cutting speed did not differ from monopolar

Current stays near the surface It runs from the tip across the superficial mucosa to the return electrode; in the published model the current density is highest at the surface and falls with depth.
No grounding pad The circuit closes at the scope tip.

No difference in cutting speed in the porcine study Earlier bipolar knives were slower; the authors attribute the change to the wider contact area at the scope tip.
A return electrode that keeps contact Return electrode on the attachment plus a conductive sheath end: more contact area than a sheath-only electrode. The authors designed it for wide lumens such as the gastric body, and the porcine study included the stomach.

Clinical evidence

What did the published comparison show?

The published comparison: 26 pigs, 19 patients with the bipolar knife, 22 monopolar patients and a thermal model; single centre.

Patient series, esophageal and colorectal ESD Single centre, monopolar arm retrospective

Frontiers in Medicine 2022, Chen, n=19

No perforation and no immediate or delayed bleeding in the 19 patients treated with the bipolar knife; en bloc resection in all, as in the 22 monopolar patients.

Read publication →

Thermal model, 10 to 120 W Simulation, not a clinical result

81 to 85%

Frontiers in Medicine 2022, Chen, in silico

Depth of thermal damage with the bipolar knife as a share of the monopolar knife's at the same power.

Read publication →

Live porcine study: esophagus, stomach, colorectum

39/39

Frontiers in Medicine 2022, Chen, n=26, in vivo

En bloc resections with the bipolar knife and no perforation; cutting time, cutting speed, wound size and histology did not differ from the monopolar knife.

Read publication →

Bipolar ESD in Türkiye

From the generator to the first case, with your team

Melekırmak Medical is the Türkiye distributor of AGS MedTech; AGS hemoclips and ERCP consumables are already part of our endoscopy portfolio. The Bipolar ESD system is being added to it. The cap on the scope, the different circuit and the habit of keeping the tip in contact are worked through with the team, and we do that before the first case.

We already do this: we read the published study with your ESD team and answer the technical questions on the generator, the cap and the knife. A demonstration in your unit, hands-on practice on a model, the manufacturer's online training for your endoscopists and our clinical team in the room for your first cases: the path we follow for every new system.

This product is not yet available for order in Türkiye. We can share the product documentation and the published studies.