Endoscopic full‐thickness resection for gastrointestinal submucosal tumors

Abstract

Endoscopic full-thickness resection (EFTR) is a "changing-concept" endoscopic resection technique, which safely allows resecting deep submucosal tumors (SMTs) in the gastrointestinal (GI) wall. It's a highly promising endoscopic procedure that allows full-thickness excision of a small piece of the complete GI wall by using only a flexible endoscope. EFTR is a meeting point between surgery and endoscopy and probably the onset of many prospective combined minimally invasive therapeutic techniques that science will explore. In this review, use of the EFTR technique for gastrointestinal SMTs is highlighted, focusing on some technical aspects, indications, contraindications and outcomes.

Endoscopic full‐thickness resection of a colonic schwannoma

“…Although generally regarded as benign lesions, malignant transformation has occasionally been described . Endoscopic resection of these and other colonic SMT originating from the muscularis propria layer remains challenging . We have previously published our initial experience with EFTR for tumors ≤3 cm, reporting a high rate of complete resection (18/19) and endoscopic closure (16/18) .…”

“…propria layer remains challenging. [2][3][4] We have previously published our initial experience with EFTR for tumors ≤3 cm, reporting a high rate of complete resection (18/19) and endoscopic closure (16/18). 5 Therefore, we have proposed EFTR as a valid treatment option when carried out by experienced endoscopists in high-volume tertiary centers.…”

Endoscopic selective muscular dissection for gastric submucosal tumor

“…Gastric submucosal tumors (G‐SMT), such as gastrointestinal stromal tumors (GIST), often arise from the muscularis propria, which consists of at least two layers (inner circle and outer longitudinal muscle). Laparoscopic and endoscopic cooperative surgery or endoscopic resection has been carried out for G‐SMT . However, these procedures require closure of the gastric wall.…”

Report from the 97th Congress of Japan Gastroenterological Endoscopy Society (JGES)

“…An interesting topic on endoscopic full‐thickness resection (EFTR) was presented and discussed in a session on the final day of the Meeting. Pure EFTR is derived from endoscopic submucosal dissection (ESD) and uses ESD‐related skills and equipment . It is considered to be a minimally invasive alternative to surgical resection.…”

“…Pure EFTR is derived from endoscopic submucosal dissection (ESD) and uses ESD-related skills and equipment. 5 It is considered to be a minimally invasive alternative to surgical resection. However, pure EFTR differs from laparoscopy-assisted EFTR, such as laparoscopy and endoscopy cooperative surgery (LECS), in that pure EFTR is a true model of the natural orifice transluminal endoscopic surgery concept.…”