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Davide Massimi: A Bloodless Approach to Third Space Endoscopy
Davide Massimi/LinkedIn
Jun 1, 2026, 14:54

Davide Massimi: A Bloodless Approach to Third Space Endoscopy

Davide Massimi, Endoscopy Consultant at Humanitas Research Hospital, shared Endoscopy Journal‘s post on LinkedIn:

“Underwater 3d space endoscopy finds its true fulfillment in underwater coagulation.

This is more than a technique: it’s the logical completion of underwater 3d space endoscopy.

If we already dissect underwater, why surface to manage vessels?

Underwater coagulation keeps the entire procedure in one continous setting:

  • one field: saline immersion and continuous irrigation
  • one device: no switching to hemostatic forceps, just knife
  • one electrosurgical setting: no ESU mode changes required, just play with saline irrigation and knife flushing

The result is a third space endoscopy that is safe, effective, efficient and, bloodless”

Endoscopy Journal shared a post on LinkedIn about a recent article by Antonio Capogreco et al., published in Endoscopy, adding:

“Vessel coagulation in third-space endoscopy: a RCT

In a randomized controlled trial, 70 patients undergoing third-space endoscopy (endoscopic submucosal dissection or peroral endoscopic myotomy) underwent prophylactic management of submucosal vessels grater than or equal to 1.2mm with either saline-immersion pre-sealing or conventional coagulation under carbon dioxide insufflation.

Intraprocedural bleeding was significantly reduced in the saline-immersion group, both per-patient (32.4% vs. 75.8%) and per-vessel (6.3% vs. 29.9%), with less need for coagulation forceps and shorter coagulation time.

Future studies should evaluate generalizability and cost–effectiveness across different operators and settings.”

Title: Vessel coagulation in third-space endoscopy: a randomized controlled trial

Authors: Antonio Capogreco, Roberta Maselli, Davide Massimi, Ludovico Alfarone, Roberto de Sire, Emanuela Morenghi, Loredana Correale, Luca Brandaleone, Elisabetta Mastrorocco, Maritalia Simone, Chiara Morelli, Marco Spadaccini, Markus Enderle, Nermin Salkic, Pradeep Bhandari, Romain Legros, Jérémie Jacques, Cesare Hassan, Alessandro Repici

Davide Massimi: A Bloodless Approach to Third Space Endoscopy

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Alessandro Repici Antonio Capogreco Cesare Hassan Chiara Morelli Davide Massimi Elisabetta Mastrorocco Emanuela Morenghi Endoscopy Endoscopy Journal Health Hematology Hemostasis Hemostasis News Hemostasis Today Jérémie Jacques Loredana Correale Luca Brandaleone Ludovico Alfarone Marco Spadaccini Maritalia Simone Markus Enderle Medicine Nermin Salkic Pradeep Bhandari Roberta Maselli Roberto de Sire Romain Legros underwater coagulation
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