Guide to endoscope selection for peroral endoscopic myotomy procedures.

Background and Aims: Peroral endoscopic myotomy (POEM) is the standard of care for achalasia treatment. Although prior studies have addressed technique, electrosurgical settings, and accessories, there is limited guidance on endoscope selection. This review highlights key characteristics, advantages, and limitations of commonly used endoscopes for POEM. Methods: Endoscopes from 3 major vendors were reviewed and compared across several parameters: distal outer diameter (OD), accessory channel size and position, working length, tip angulation, and ergonomics. Results: Scopes with a 3.2-mm accessory channel demonstrated greater suction capacity than 2.8-mm channels when accessory tools are in place. Vendor 1 (Olympus, Center Valley, Pa, USA) offers a slim pediatric colonoscope with a 3.2-mm channel and high maneuverability, maintaining a comparable OD to other scopes. Newer diagnostic endoscopes from vendor 2 (Fujifilm, Tokyo, Japan), including slim designs with 7.9-mm OD and 3.2-mm channels, provide enhanced suction and tip control. Conclusions: Various endoscopes are suitable for POEM, each with specific tradeoffs. Slim colonoscopes offer better maneuverability but may limit device compatibility. Intermediate-length scopes and newer 3.2-mm diagnostic scopes improve function and flexibility. Endoscopy units performing third-space procedures should consider adopting diagnostic scopes with 3.2-mm channels, which may represent a future standard of care.