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Background and Aims: Endoscopic full-thickness resection (EFTR) is an emerging technique for the treatment of various conditions for which classic endoscopic resection techniques have failed or were considered to be at high risk for perforation. The full-thickness resection device (FTRD) is an over-the-scope system which allows a single-step EFTR. The aim of our study is to describe our experience in EFTR of colorectal lesions using the FTRD. Methods: Nine patients (10 colorectal lesions) were proposed for EFTR. Safety, R0 resection and endoscopic treatment success were evaluated. Results: Reasons for referral included nonlifting adenomas (n = 4), nonlifting adenoma recurrence (n = 5), and submucosal lesion (n = 1). EFTR was technically successful in all patients. The mean duration of the procedure was 55 min. R0 resection was obtained in all patients. No major complications were detected. All lesions were successfully treated by the endoscopic technique and no patient was referred for surgery. In patients with available follow-up (n = 6), no recurrence was detected. Conclusions: EFTR is a feasible, reasonable time-consuming, safe, and promising endoscopic resection technique. Key Messages: FTRD is an additional tool for difficult-to-treat colorectal lesions.

<b><i>Background:</i></b> Narrow-band imaging (NBI) allows “in vivo” classification of colorectal polyps. <b><i>Objectives:</i></b> We evaluated the optical diagnosis by nonexpert community-based endoscopists in routine clinical practice, the impact of training, and whether the endoscopists could achieve the threshold for the “do not resect” policy. <b><i>Methods:</i></b> This was an observational study performed in two periods (P1 and P2). Endoscopists had no prior experience in NBI in P1 and applied the technique on a daily basis for 1 year before participation in P2. Lesions were classified by applying the NBI International Colorectal Endoscopic (NICE) and Workgroup serrAted polypS and Polyposis (WASP) classifications, simultaneously. <b><i>Results:</i></b> A total of 290 polyps were analyzed. The overall accuracy of optical diagnosis was 0.75 (95% CI 0.68–0.81) in P1, with an increase to 0.82 (95% CI 0.73–0.89) in P2 (<i>p</i> = 0.260). The accuracy of the NICE/WASP classifications to differentiate adenomatous from nonadenomatous histology was 0.78 (95% CI 0.72–0.84) in P1 and 0.86 (95% CI 0.77–0.92) in P2 (<i>p</i> = 0.164); assignments made with a high confidence level achieved statistical significance (13% improvement, 95% CI 3–22%; <i>p</i> = 0.022). The negative predictive value for adenomatous histology of diminutive rectosigmoid polyps was 81% (95% CI 64–93%) and 80% (95% CI 59–93%) in P1 and P2, respectively. <b><i>Conclusions:</i></b> Nonexpert endoscopists achieved moderate accuracy for real-time optical diagnosis of colorectal lesions with the NICE/WASP classifications. The overall performance of the endoscopists improved after sustained use of optical diagnosis, but did not achieve the standards for the implementation of the “do not resect” strategy.

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Ressecção endoscópica de tumor neuroendócrino duodenal com um novo dispositivo de ressecção transmural Palavras ChaveEndoscopia · Duodeno · Tumor neuroendócrino · Ressecção transmural Most well-differentiated, non-functional duodenal neuroendocrine tumours (NETs) limited to the mucosa/ submucosa can be treated effectively with endoscopic resection [1]. A full-thickness resection device (FTRD; Ovesco Endoscopy ® ) enables endoscopic transmural resection of suitable lesions with a fast minimally invasive technique [2]. A colonic FTRD was used for duodenal lesions as an "off-label" indication with good clinical outcomes and a complication rate comparable to duodenal endoscopic mucosal resection [3]. A duodenal FTRD (d-FTRD) with smaller diameter (19.5 vs. 21 mm), balloonassisted insertion and less clip interdental space was developed allowing easier upper oesophageal sphincter passage and minimising bleeding risk.We describe a 74-year-old male with a 10-mm postpyloric bulbar submucosal lesion (Fig. 1, 2) with biopsies showing a well-differentiated NET. Endoscopic ultrasonography showed a submucosal lesion. Endoscopic ultrasonography and 68-Ga DOTA-NOC PET/CT displayed no lymph node involvement or distant metastases. An attempt to resect with band ligation endoscopic mucosal resection failed because of an absence of aspiration into the cap. Transmural resection with the d-FTRD was scheduled in the operating room under general anaesthesia. Lesion borders were marked with argon plasma coagulation. Upper oesophageal sphincter dilation was performed with Savary-Gilliard bougie dilator (15-18 mm) allowing d-FTRD insertion. A paediatric colonoscope (outer diameter: 11.8 mm; working channel calibre: 3.2 mm) was then advanced to the duodenum with the d-FTRD attached. Traction of the lesion to the cap with the grasper and slight aspiration were done, followed by overthe-scope clip release (d-FTRD clip). Aspiration was nec-This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.

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Radiofrequency ablation therapy is an effective endoscopic option for the eradication of Barrett’s esophagus that appears to reduce the risk of esophageal cancer. A concern associated with this technique is the development of subsquamous/buried intestinal metaplasia, whose clinical relevance and malignant potential have not yet been fully elucidated. Fewer than 20 cases of subsquamous neoplasia after the successful radiofrequency ablation of Barrett’s esophagus have been reported to date. Here, we describe a new case of subsquamous neoplasia (high-grade dysplasia) following radiofrequency ablation that was managed with endoscopic resection. Our experience suggests that a meticulous endoscopic inspection prior to and after radiofrequency ablation is fundamental to reduce the risk of buried neoplasia development.

Pyogenic granuloma is a benign vascular lesion, uncommon in the gastrointestinal tract, and extremely rare in the small bowel. The diagnosis can be challenging prior to surgery, because of its unusual endoscopic appearance.We present a case of pyogenic granuloma of the jejunum diagnosed by capsule endoscopy and double-balloon enteroscopy and successfully managed by surgical resection.