Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience

Background and study aims: Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract may be a valuable therapeutic and diagnostic approach for a variety of indications. Although feasibility of EFTR has been demonstrated, there is a lack of safe and effective endoscopic devices for routine use. The aim of this study was to investigate the efficacy and safety of a novel over-the-scope device for colorectal EFTR.

Patients and methods: Between July 2012 and July 2014, 25 patients underwent EFTR at two tertiary referral centers. All resections were performed using the full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Data were collected retrospectively.

Results: Indications for EFTR were: recurrent or incompletely resected adenoma with nonlifting sign (n = 11), untreated adenoma and nonlifting sign (n = 2), adenoma involving the appendix (n = 5), flat adenoma in a patient with coagulopathy (n = 1), diagnostic re-resection after incomplete resection of a T1 carcinoma (n = 2), adenoma involving a diverticulum (n = 1), submucosal tumor (n = 2), and diagnostic resection in a patient with suspected Hirschsprung’s disease (n = 1). In one patient, the lesion could not be reached because of a sigmoid stenosis. In the other patients, resection of the lesion was macroscopically complete and en bloc in 20/24 patients (83.3 %). The mean diameter of the resection specimen was 24 mm (range 12 – 40 mm). The R0 resection rate was 75.0 % (18/24), and full-thickness resection was histologically confirmed in 87.5 %. No perforations or major bleeding were observed during or after resection. Two patients developed postpolypectomy syndrome, which was managed with antibiotic therapy.

Conclusions: Full-thickness resection in the lower gastrointestinal tract with the novel FTRD was feasible and effective. Prospective studies are needed to further evaluate the device and technique.

^* These authors contributed equally to this work.

• References

• 1 Maguire LH, Shellito PC. Endoscopic piecemeal resection of large colorectal polyps with long-term followup. Surg Endosc 2014; 28: 2641-2648
• 2 Kuroki Y, Hoteya S, Mitani T et al. Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors. J Gastroenterol Hepatol 2010; 25: 1747-1753
• 3 Sakamoto T, Saito Y, Matsuda T et al. Treatment strategy for recurrent or residual colorectal tumors after endoscopic resection. Surg Endosc 2011; 25: 255-260
• 4 Moss A, Williams SJ, Hourigan LF et al. 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 2015; 64: 57-65
• 5 Mönkemüller K, Peter S, Toshniwal J et al. Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 2014; 26: 350-357
• 6 Sarker S, Gutierrez JP, Council L et al. Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract. Endoscopy 2014; 46: 758-761
• 7 Fähndrich M, Sandmann M. Endoscopic full-thickness resection for gastrointestinal lesions using the over-the-scope clip system: a case series. Endoscopy 2015; 47: 76-79
• 8 Schurr MO, Baur F, Ho CN et al. Endoluminal full-thickness resection of GI lesions: a new device and technique. Minim Invasive Ther Allied Technol 2011; 20: 189-192
• 9 Schurr MO, Baur FE, Krautwald M et al. Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study. In press 2015. Surg Endosc
• 10 von Renteln D, Rösch T, Kratt T et al. Endoscopic full-thickness resection of submucosal gastric tumors. Dig Dis Sci 2012; 57: 1298-1303
• 11 von Renteln D, Kratt T, Rösch T et al. Endoscopic full-thickness resection in the colon by using a clip-and-cut technique: an animal study. Gastrointest Endosc 2011; 74: 1108-1114
• 12 Schmidt A, Damm M, Caca K. Endoscopic full thickness resection using a novel over-the-scope device. Gastroenterolgy 2014; 47: 740-742
• 13 Valli PV, Kaufmann M, Vrugt B et al. Endoscopic resection of a diverticulum-arisen colonic adenoma using a full-thickness resection device. Gastroenterology 2014; 147: 969-971
• 14 Weiland T, Fehlker M, Gottwald T et al. Performance of the OTSC system in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 2013; 27: 2258-2274
• 15 Voermans 1st RP, Le MoineO, von Renteln D et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10: 603-608
• 16 von Renteln D, Schmidt A, Vassiliou MC et al. Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 2009; 41: 481-486
• 17 von Renteln D, Schmidt A, Vassiliou MC et al. Endoscopic full-thickness resection and defect closure in the colon. Gastrointest Endosc 2010; 71: 1267-1273
• 18 Schlag C, Wilhelm D, von Delius S et al. EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors. Endoscopy 2013; 45: 4-11
• 19 Xu M, Wang XY, Zhou PH et al. Endoscopic full-thickness resection of colonic submucosal tumors originating from the muscularis propria: an evolving therapeutic strategy. Endoscopy 2013; 45: 770-773
• 20 Raju GS, Malhotra A, Ahmed I. Colonoscopic full-thickness resection of the colon in a porcine model as a prelude to endoscopic surgery of difficult colon polyps: a novel technique (with videos). Gastrointest Endosc 2009; 70: 159-165
• 21 Kopelman Y, Siersema PD, Bapaye A et al. Endoscopic full-thickness GI wall resection: current status. Gastrointest Endosc 2012; 75: 165-173
• 22 Kantsevoy SV. Endoscopic full-thickness resection: new minimally invasive therapeutic alternative for GI-tract lesions. Gastrointest Endosc 2006; 64: 90-91
• 23 Schmidt A, Riecken B, Damm M et al. Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 2014; 46: 762-766
• 24 Schostek S, Ho CN, Melbert M et al. DC current pulses for OTSC clip fragmentation: technology and experimental study. In press 2015. Surg Endosc