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

Abstract

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, T?bingen, 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.

Endoscopic full thickness resection (EFTR) of colorectal neoplasms with the Full Thickness Resection Device (FTRD): Clinical experience from two tertiary referral centers in Switzerland

“…En bloc-R0 resection was achieved in 29/33 patients (87.9%), which compares favorably to the results of previous studies (75%-80.6%) 19,20 as well as to the preliminary data available from the Wall Resect Study (76.6%). The overall rate of histologically proven FTR of 80.6% (colon 90.0%, rectum 63.6%) was slightly below the rate of 87.5% published by Schmidt et al This may be explained by the higher percentage of lesions located in the rectum in our study (36.4% vs 8%).…”

“…To our knowledge, this is the largest series of FTRD in consecutive patients so far. To date, four case reports [15][16][17][18] and two retrospective studies have been published, 19,20 the latter two comprising a total of 45 cases. More data are expected from the Wall Resect Study, which completed patient recruitment in April 2016 and at present provides preliminary data from 181 patients.…”

Endoscopic full-thickness resection of a submucosal right colon lesion

“…A novel endoscopic full-thickness resection device (Ovesco Endoscopy, Tübin-gen, Germany) has been developed based on the combination of an overthe-scope clip with an enlarged resection cap (21 mm) and a snare preloaded in the distal rim of the cap [1,2]. We report the case of a 53-year-old woman with a history of abdominal panniculitis with fat necrosis and perivasculitis with giant cell histiocytosis.…”

Endoscopic Full-Thickness Resection of a Colonic Lateral Spreading Tumor

“…The feasibility and effectiveness of this procedure was shown in several case series and 2 retrospective studies, with few complications reported [4,6,7]. Recently, the results of the Wall Resect study, the first prospective multicenter trial, were published.…”