Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD®)
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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.
KeywordsEndoscopic 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
Full-thickness resection device
Endoscopic full-thickness resection
We sincerely thank PD Dr. Christoph Gubler for his assistance in the performance of some interventions.
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.
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