Endoscopic full-thickness resection (EFTR) allows for the management of scarred and fibrotic lesions that are not amenable to endoscopic mucosal resection or endoscopic submucosal dissection (ESD). Two main methods of performing EFTR include exposed and nonexposed EFTR. In exposed EFTR, the lesion is resected followed by defect closure. In nonexposed EFTR, the defect is closed prior to resection of the lesion.
The Padlock FTR System (Steris, Mentor, Ohio, USA) is a novel full-thickness resection (FTR) device that includes a Padlock design clip to achieve nonexposed EFTR and then uses a pre-loaded snare to resect the lesion ([Fig. 1]). To the best of our knowledge, we show the first reported case of in-human use of this device ([Video 1]).
Fig. 1 Dedicated, novel full-thickness resection device that includes a clip and pre-loaded snare for lesion resection.
Qualität:
Resection of a large sigmoid polyp using a novel full-thickness resection device.Video 1
A 60-year-old man with a history of >20 polyps and prior ESD for three 4- to 6-cm rectosigmoid polyps presented for endoscopic resection of a rectosigmoid polyp adjacent to a prior ESD resection site. A 20-mm sessile polyp was found in the sigmoid colon next to a previously placed cinch at the site of a prior polyp resection. Given extensive scarring at the site, the decision was made to pursue EFTR. The polyp was successfully resected using this novel FTR device ([Fig. 2]). No adverse events occurred. Examination of the resection site showed the fatty patch, consistent with full-thickness resection, and the clip in place ([Fig. 3]). Pathology revealed a well-differentiated, invasive adenocarcinoma with a depth of submucosal invasion of 600 microns ([Fig. 4]). Deep and lateral margins were negative (R0 resection) for dysplasia.
Fig. 2 Successful resection of the 20-mm sigmoid polyp using the novel full-thickness resection device.
Fig. 3 Post-resection examination showed the fatty patch, consistent with full-thickness resection. The clip was in the appropriate position.
Fig. 4 Invasive adenocarcinoma with submucosal invasion to a depth of 600 microns. Deep and lateral margins were negative (R0 resection).
This device could be a useful tool in the armamentarium for EFTR of previously manipulated colon polyps and lesions with superficial submucosal invasion. Further reports are needed to confirm its safety and efficacy.
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E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
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