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.
