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

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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.

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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

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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.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Zurich University Hospital, Zurich, Switzerland

    P. V. Valli, J. Mertens & P. Bauerfeind

Authors
  1. P. V. Valli
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  2. J. Mertens
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  3. P. Bauerfeind
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Corresponding author

Correspondence to P. Bauerfeind.

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Disclosures

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

464_2017_5676_MOESM1_ESM.tif

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

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

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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Valli, P.V., Mertens, J. & Bauerfeind, P. Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD®). Surg Endosc 32, 289–299 (2018). https://doi.org/10.1007/s00464-017-5676-9

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  • DOI: https://doi.org/10.1007/s00464-017-5676-9

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