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


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.


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.


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.


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



Endoscopic mucosal resection


Endoscopic submucosal dissection


Submucosal tunneling endoscopic resection


Laparoscopy-assisted endoscopic full-thickness resection


Natural orifice transluminal endoscopic surgery




Over-the-scope clip


Full-thickness resection device


Endoscopic full-thickness resection



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


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.


  1. 1.
    Maguire LH, Shellito PC (2014) Endoscopic piecemeal resection of large colorectal polyps with long-term followup. Surg Endosc 28:2641–2648CrossRefPubMedGoogle Scholar
  2. 2.
    Ye LP, Zhang Y, Mao XL, Zhu LH, Zhou X, Chen JY (2014) Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc 28:524–530CrossRefPubMedGoogle Scholar
  3. 3.
    Lu J, Jiao T, Li Y et al (2015) Heading toward the right direction–solution package for endoscopic submucosal tunneling resection in the stomach. PLoS ONE 10:e0119870CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Maselli R, Santi G (2016) Submucosal tunnel endoscopy: peroral endoscopic myotomy and peroral endoscopic tumor resection. World J Gastrointest Endosc 8:86–103CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kuroki Y, Hoteya S, Mitani T et al (2010) Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors. J Gastroenterol Hepatol 25:1747–1753CrossRefPubMedGoogle Scholar
  6. 6.
    Sakamoto T, Saito Y, Matsuda T, Fukunaga S, Nakajima T, Fujii T (2011) Treatment strategy for recurrent or residual colorectal tumors after endoscopic resection. Surg Endosc 25:255–260CrossRefPubMedGoogle Scholar
  7. 7.
    Moss A, Williams SJ, Hourigan LF et al (2015) Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 64:57–65CrossRefPubMedGoogle Scholar
  8. 8.
    Abe N, Takeuchi H, Yanagida O et al (2009) Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 23:1908–1913CrossRefPubMedGoogle Scholar
  9. 9.
    Cho WY, Kim YJ, Cho JY et al (2011) Hybrid natural orifice transluminal endoscopic surgery: endoscopic full-thickness resection of early gastric cancer and laparoscopic regional lymph node dissection–14 human cases. Endoscopy 43:134–139CrossRefPubMedGoogle Scholar
  10. 10.
    Kirschniak A, Kratt T, Stuker D, Braun A, Schurr MO, Konigsrainer A (2007) A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest endosc 66(1):162–167CrossRefPubMedGoogle Scholar
  11. 11.
    Honegger C, Valli P, Wiegand N, Bauerfeind P, Gubler C (2016) Establishment of over-the-scope-clips (OTSC®) in daily endoscopic routine. United Eur Gastroenterol J 5(2):247–254CrossRefGoogle Scholar
  12. 12.
    Weiland T, Fehlker M, Gottwald T, Schurr MO (2013) Performance of the OTSC system in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 27:2258–2274CrossRefPubMedGoogle Scholar
  13. 13.
    Voermans RP, Le Moine O, von Renteln D et al (2012) Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 10:603–608CrossRefPubMedGoogle Scholar
  14. 14.
    von Renteln D, Schmidt A, Vassiliou MC, Rudolph HU, Gieselmann M, Caca K (2009) Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 41:481–486CrossRefGoogle Scholar
  15. 15.
    Sarker S, Gutierrez JP, Council L, Brazelton JD, Kyanam Kabir Baig KR, Monkemuller K (2014) Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract. Endoscopy 46(9):758–761CrossRefPubMedGoogle Scholar
  16. 16.
    von Renteln D, Schmidt A, Vassiliou MC, Rudolph HU, Caca K (2010) Endoscopic full-thickness resection and defect closure in the colon. Gastrointest Endosc 71:1267–1273CrossRefGoogle Scholar
  17. 17.
    Valli PV, Kaufmann M, Vrugt B, Bauerfeind P (2014) Endoscopic resection of a diverticulum-arisen colonic adenoma using a full-thickness resection device. Gastroenterology 147:969–971CrossRefPubMedGoogle Scholar
  18. 18.
    Schmidt A, Meier B, Caca K (2015) Endoscopic full-thickness resection: current status. WJG 21:9273–9285CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Schmidt A, Bauerfeind P, Gubler C, Damm M, Bauder M, Caca K (2015) Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy 47:719–725CrossRefPubMedGoogle Scholar
  20. 20.
    Schurr MO, Baur F, Ho CN, Anhoeck G, Kratt T, Gottwald T (2011) Endoluminal full-thickness resection of GI lesions: a new device and technique. MITAT 20:189–192PubMedGoogle Scholar
  21. 21.
    Hassan C, Quintero E, Dumonceau JM et al (2013) Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 45:842–851CrossRefPubMedGoogle Scholar
  22. 22.
    Fahndrich M, Sandmann M (2015) Endoscopic full-thickness resection for gastrointestinal lesions using the over-the-scope clip system: a case series. Endoscopy 47:76–79PubMedGoogle Scholar
  23. 23.
    Monkemuller K, Peter S, Toshniwal J et al (2014) Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 26:350–357CrossRefPubMedGoogle Scholar
  24. 24.
    Xu J, Yang L, Guo Y, Zhao D, Wang L, Bai L (2010) Perforation of sigmoid diverticulum following endoscopic polypectomy of an adenoma. BMJ Case Rep. doi: 10.1136/bcr.07.2009.2077 PubMedPubMedCentralGoogle Scholar
  25. 25.
    Barr YR, Brazowski E, Leider-Trejo L (2006) Villous adenoma in a perforated colonic diverticulum. Int J Colorectal Dis 21:282–284CrossRefPubMedGoogle Scholar
  26. 26.
    Adrales GL, Harold KL, Matthews BD, Sing RF, Kercher KW, Heniford BT (2002) Laparoscopic “radical appendectomy” is an effective alternative to endoscopic removal of cecal polyps. J Laparoendosc Adv Surg Tech A 12:449–452CrossRefPubMedGoogle Scholar
  27. 27.
    Denoel C, Legrand MJ, Heymans O, Kunsch JM (2001) Isolated adenomatous polyposis of the appendix: report of a case. Dis Colon Rectum 44:1709–1710CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyZurich University HospitalZurichSwitzerland

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