ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection

ASGE Technology Committee, Harry R Aslanian, Amrita Sethi, Manoop S Bhutani, Adam J Goodman, Kumar Krishnan, David R Lichtenstein, Joshua Melson, Udayakumar Navaneethan, Rahul Pannala, Mansour A Parsi, Allison R Schulman, Shelby A Sullivan, Nirav Thosani, Guru Trikudanathan, Arvind J Trindade, Rabindra R Watson, John T Maple, ASGE Technology Committee, Harry R Aslanian, Amrita Sethi, Manoop S Bhutani, Adam J Goodman, Kumar Krishnan, David R Lichtenstein, Joshua Melson, Udayakumar Navaneethan, Rahul Pannala, Mansour A Parsi, Allison R Schulman, Shelby A Sullivan, Nirav Thosani, Guru Trikudanathan, Arvind J Trindade, Rabindra R Watson, John T Maple

Abstract

With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as "exposed" and "nonexposed." In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.

Keywords: EFTR, endoscopic full-thickness resection; ESD, endoscopic submucosal dissection; GIST, GI stromal tumor; NOTES, natural orifice transluminal endoscopic surgery; OTSC, over-the-scope clip; POEM, per-oral endoscopic myotomy; PTFE, polytetrafluoroethylene; SET, subepithelial tumor; STER, submucosal tunnel endoscopic resection; TTS, through-the-scope.

Figures

Figure 1
Figure 1
A, Nontunneled exposed endoscopic full-thickness resection. Dissection around a subepithelial lesion with disruption of the muscularis propria, followed by defect closure. B, Submucosal tunnel endoscopic resection. Submucosal tunneling is performed to access a submucosal lesion, which is resected and removed through the tunnel, followed by closure of the tunnel entry site.
Figure 2
Figure 2
Nonexposed endoscopic full-thickness resection. Full-thickness duplication of the intestinal wall (A) is performed before resection of the lesion (B).
Figure 3
Figure 3
Full-thickness resection device (Ovesco Endoscopy Tubingen, Germany).
Figure 4
Figure 4
GERDX Device (G-Surg, Seeon, Germany).

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Source: PubMed

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