Endoscopic full-thickness resection: Current status

Abstract

Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.

Keywords: Colorectal adenoma; Colorectal carcinoma; Endoscopic full-thickness resection; Endoscopic gastrointestinal surgery; Over-the-scope-clip.

Figures

Figure 1

Endoscopic full-thickness resection with prior transmural suturing. A: Transmural sutures are placed underneath a subepithelial tumor (schematic illustration); B: The sutures are securing gastric wall patency after full-thickness resection; C: The GERDXTM device (G-Surg, Seeon, Germany); D: The tip of GERDXTM device with opened branches and the central tissue retractor.

Figure 2

Endoscopic full-thickness resection of a gastric gastrointestinal stromal tumors after prior transmural suturing. A: Endoscopic image of the subepithelial tumor in the gastric corpus; B: EUS-image showing an inhomogeneous tumor arising from the muscularis propria; C: Two transmural sutures are deployed underneath the tumor using the PlicatorTM suturing device; D: EUS image after suturing. The PTFE pledges are indicated with arrows; E: Resection site. The transmural sutures are securing gastric wall patency; F: EUS image of the resection site. The PTFE pledges are indicated with arrows. EUS: Endoscopic ultrasonography.

Figure 3

Full thickness resection device (Ovesco Endoscopy, Tuebingen, Germany). A: Tip of a colonoscope with the mounted FTRD. A grasping forceps is advanced through the working channel of the scope; B: The assembled FTRD on a colonoscopy. FTRD: Full thickness resection device.

Figure 4

Schematic image of the resection procedure with the full-thickness resection device. A: The lesion is grasped with a forceps and pulled into the cap thereby creating a full-thickness duplication of the colonic wall; B: The over-the-scope clip is deployed; C: The tissue above the clip is resected with the integrated snare.

Figure 5

Endoscopic full thickness resection of a non-lifting recurrent adenoma in a patient with a polyposis syndrome. A: Endoscopic image showing a polypoid and centrally depressed non-lifting adenoma (2.5 cm) in the sigmoid (Narrow band imaging mode); B: View with the mounted full thickness resection device (FTRD, Ovesco Endoscopy, Tübingen, Germany); C: The lesion is pulled into the cap with a forceps; D: Resection site. The over-the-scope clip is securing gastric wall patency.