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Over-the-scope clip-assisted endoscopic full thickness resection: a video-based case series

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Abstract

Background

In the management of mucosal neoplasm and early cancer, therapeutic gastrointestinal endoscopy evolved from simply polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection (ESD), to endoscopic full thickness resection (EFTR). Full thickness clip closure followed by transmural resection mimics surgical principles. It is safe, effective, and technically less demanding compared to other techniques. Over-the-scope clip (OTSC)-assisted EFTR or OTSC-EFTR enables the endoscopists to manage difficult lesions.

Methods

We video recorded and report our 1-year single center experience of 12 consecutive EFTR cases since the dedicated OTSC-EFTR device was approved in the USA.

Results

We demonstrate that OTSC-EFTR can be very useful to manage residual neoplastic tissue that cannot be removed during conventional mucosal resection due to deeper invasion, submucosal fibrosis, scaring from prior intervention, and appendiceal involvement. Caution should be used for EFTR of the ileocecal valve lesions.

Conclusion

We propose that layered or stacked biopsy of the appendiceal stump after EFTR should be performed to rule out a positive residual base. Due to the limited size of the FTRD resection hood (13 mm internal diameter × 23 mm depth), for larger sessile adenomas in the colon, we propose a hybrid approach for complete removal: piecemeal EMR for tumor debulking followed by OTSC-EFTR to achieve R0 resection. We believe OTSC-EFTR offers safety and efficiency with very high success rate.

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Authors and Affiliations

  1. Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Shou-jiang Tang, Yehia M. Naga & Ruonan Wu

  2. Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China

    Shengyu Zhang

Authors
  1. Shou-jiang Tang
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  2. Yehia M. Naga
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Correspondence to Shou-jiang Tang.

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Disclosures

Dr. Shou-jiang Tang, Dr. Yehia Naga, Ruonan Wu, Dr. Shengyu Zhang has no conflicts of interest or financial ties to disclose.

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Tang, Sj., Naga, Y.M., Wu, R. et al. Over-the-scope clip-assisted endoscopic full thickness resection: a video-based case series. Surg Endosc 34, 2780–2788 (2020). https://doi.org/10.1007/s00464-020-07481-z

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