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Surgical Endoscopy

, Volume 32, Issue 1, pp 289–299 | Cite as

Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD®)

  • P. V. Valli
  • J. Mertens
  • P. BauerfeindEmail author
Article

Abstract

Background and study aims

Classic endoscopic resection techniques (EMR and ESD) are limited to mucosal lesions. In the case of deeper growth into the gut wall and anatomic sites prone to perforation, the novel full-thickness resection device (FTRD®) opens a new dimension of possibilities for endoscopic resection.

Patients and methods

Sixty patients underwent endoscopic full-thickness resection (eFTR) at our institution. Safety, learning curve, R0 resection rate, and clinical outcome were studied.

Results

In 97% (58/60) of the interventions, the FTRD®-mounted endoscope reached the previously marked lesion and eFTR was performed (technical success). Full-thickness resection was achieved in 88% of the cases, with an R0 resection on histological examination in 79%. The clinical success rate based on follow-up histology was even higher (88%). Adverse events occurred in 7%. Appendicitis of the residual cecal appendix after eFTR of an adenoma arising in the appendix led to the only post-eFTR surgery (1/58, 2%). Minor bleeding at the eFTR site (2/58, 3%) and an eFTR performed accidently without proper prior deployment of the OTSC® (1/58, 2%) were successfully treated endoscopically. There was no secondary perforation or eFTR-associated mortality.

Conclusions

After specific training, eFTR is a feasible, safe, and promising all-in-one endoscopic resection technique. Our data show that eFTR allows complete resection of lesions affecting layers of the gut wall beneath the mucosa with a low risk of adverse events. However, our preliminary results need to be confirmed in larger, controlled studies.

Keywords

Endoscopic full-thickness resection (eFTR) Full-thickness resection device (FTRD®Recurrent adenoma Non-lifting adenoma Endoscopic appendectomy 

Abbreviations

EMR

Endoscopic mucosal resection

ESD

Endoscopic submucosal dissection

STER

Submucosal tunneling endoscopic resection

LAEFR

Laparoscopy-assisted endoscopic full-thickness resection

NOTES

Natural orifice transluminal endoscopic surgery

GI

Gastrointestinal

OTSC®

Over-the-scope clip

FTRD®

Full-thickness resection device

eFTR

Endoscopic full-thickness resection

Notes

Acknowledgements

We sincerely thank PD Dr. Christoph Gubler for his assistance in the performance of some interventions.

Author contributions

PVV: Editing of results and manuscript, performance of endoscopies. JM: Critical reading and editing of the manuscript. PB: Revision of the manuscript, performance of endoscopies.

Compliance with ethical standards

Disclosures

P. V. Vall, J. Mertens, and P. Bauerfeind have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2017_5676_MOESM1_ESM.tif (1 mb)
Supplementary material 1 (TIFF 1035 kb). Supplemental Figure 6A Recurrent adenoma after prior polypectomy; B Full-thickness resection specimen, peritoneal face; C Full-thickness resection specimen, adenoma face with all marks included within the resection limits.
464_2017_5676_MOESM2_ESM.tiff (1.3 mb)
Supplementary material 2 (TIFF 1321 kb). Supplemental Figure 7A Full-thickness resection device (FTRD®), including a hyperthermic snare, running along a standard endoscope; B OTSC® mounted onto a transparent cap containing the resection snare, then fitted on the tip of the endoscope.
464_2017_5676_MOESM3_ESM.tif (534 kb)
Supplementary material 3 (TIFF 534 kb). Supplemental Figure 8 (kindly provided by Ovesco® Endoscopy AG, Tübingen), step 1: After mounting the FTRD®, the endoscope is advanced to the previously marked lesion; step 2: The target lesion is grabbed with a grasping forceps; step 3: The target lesion is carefully pulled into the plastic cap of the FTRD®, step 4: The OTSC® is deployed; step 5: The eFTR is performed using the hyperthermic snare within the plastic cap.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyZurich University HospitalZurichSwitzerland

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