Skip to main content
SpringerLink
Log in

Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video)

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Clip-assisted endoscopic full-thickness resection (EFTR) with an over-the-scope device has been recently described to be feasible and effective for the resection of non-lifting adenomas in the lower gastrointestinal tract. However, tumor size is the major limitation of that technique. We describe a hybrid technique using endoscopic mucosal resection (EMR) in ten patients with large non-lifting colorectal adenomas to reduce tumor size and facilitate clip-assisted EFTR.

Methods

Data of ten consecutive patients (median age 72.5 years, SD 8.86) who underwent combined EMR and EFTR in the colon were analyzed retrospectively. The main outcome measures were technical success, histological confirmation of full-thickness resection, and adverse events.

Results

All lesions (median size 35.5 mm, SD 5.99) could be resected successfully. No immediate or delayed adverse events were observed. Histology confirmed full-thickness resection in all cases. Three-month follow-up showed no residual or recurrent adenomas.

Conclusions

Hybrid EMR–EFTR in the colon seems to be an effective approach for large non-lifting lesions with positive lateral lifting signs. Prospective studies are needed to further evaluate efficacy, safety, rate of recurrence, and long-term outcome of this technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

(Reprinted with permission from Ovesco Endoscopy, Tübingen, Germany)

Fig. 2

(Reprinted with permission from Ovesco Endoscopy, Tübingen, Germany)

Fig. 3

Similar content being viewed by others

Abbreviations

CE:

Conformité Européenne

d:

Days

EFTR:

Endoscopic full-thickness resection

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

F:

Female

FTRD:

Full-thickness resection device

GI:

Gastrointestinal

LST-G:

Lateral spreading type-granular

M:

Male

min:

Minutes

mm:

Millimeters

NBI:

Narrow band imaging

NICE:

NBI (narrow band imaging) international colorectal endoscopic

OTSC:

Over-the-scope clip

R0:

Complete resection

y:

Years

References

  1. Schurr MO, Baur FE, Krautwald M et al (2015) Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study. Surg Endosc 29(8):2434–2441

    Article  PubMed  Google Scholar 

  2. Schmidt A, Damm M, Caca K (2014) Endoscopic full-thickness resection using a novel over-the-scope device. Gastroenterology 147(4):740–742

    Article  PubMed  Google Scholar 

  3. Richter-Schrag HJ, Walker C, Thimme R, Fischer A (2016) [Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon]. Chirurg 87(4):316–325

    Article  PubMed  Google Scholar 

  4. 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(8):719–725

    Article  PubMed  Google Scholar 

  5. Schmidt A, Riecken B, Damm M, Cahyadi O, Bauder M, Caca K (2014) Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 46(9):762–766

    Article  PubMed  Google Scholar 

  6. Schostek S, Ho CN, Melbert M et al (2015) DC current pulses for OTSC clip fragmentation: technology and experimental study. Surg Endosc 29(8):2418–2422

    Article  PubMed  Google Scholar 

  7. 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(11):1747–1753

    Article  PubMed  Google Scholar 

  8. Maguire LH, Shellito PC (2014) Endoscopic piecemeal resection of large colorectal polyps with long-term followup. Surg Endosc 28(9):2641–2648

    Article  PubMed  Google Scholar 

  9. 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(1):57–65

    Article  PubMed  Google Scholar 

  10. Rahmi G, Tanaka S, Ohara Y et al (2015) Efficacy of endoscopic submucosal dissection for residual or recurrent superficial colorectal tumors after endoscopic mucosal resection. J Dig Dis 16(1):14–21

    Article  PubMed  Google Scholar 

  11. 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(1):255–260

    Article  PubMed  Google Scholar 

  12. Fujiya M, Tanaka K, Dokoshi T et al (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81(3):583–595

    Article  PubMed  Google Scholar 

  13. Schmidt A, Meier B, Caca K (2015) Endoscopic full-thickness resection: Current status. World J Gastroenterol 21(31):9273–9285

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kopelman Y, Siersema PD, Nir Y et al (2009) Endoluminal compression clip: full-thickness resection of the mesenteric bowel wall in a porcine model. Gastrointest Endosc 70(6):1146–1157

    Article  PubMed  Google Scholar 

  15. Zhou PH, Yao LQ, Qin XY et al (2011) Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 25(9):2926–2931

    Article  PubMed  Google Scholar 

  16. Sarker S, Gutierrez JP, Council L, Brazelton JD, Baig KRKK, Monkemuller K (2014) Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract. Endoscopy 46(9):758–761

    Article  PubMed  Google Scholar 

  17. Walz B, von RD, Schmidt A, Caca K (2011) Endoscopic full-thickness resection of subepithelial tumors with the use of resorbable sutures (with video). Gastrointest Endosc 73(6):1288–1291

    Article  PubMed  Google Scholar 

  18. Fischer A, Knoop RF, Walker C, Thimme R, Richter-Schrag HJ (2015) Resection of a large rectal polyp with the simultaneous combination of snare polypectomy and full-thickness resection device resection. Endoscopy 47(Suppl 1):E607–E608

    PubMed  Google Scholar 

Download references

Acknowledgements

We thank Ovesco Endoscopy for the technical support. We also thank Professor Dr. Hermann and Dr. Mühleisen from the Department of Pathology at our institution for providing the histologic images.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany

    Benjamin Meier, Karel Caca & Arthur Schmidt

Authors
  1. Benjamin Meier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karel Caca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arthur Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Meier.

Ethics declarations

Disclosures

Prof. Caca and Dr. Schmidt have received lecture fees for FTRD training courses from Ovesco Endoscopy. Dr. Meier has no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MOV 85064 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meier, B., Caca, K. & Schmidt, A. Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video). Surg Endosc 31, 4268–4274 (2017). https://doi.org/10.1007/s00464-017-5461-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5461-9

Keywords

Search

Navigation