Colon Sparing Endoscopic Full-Thickness Resection for Advanced Colorectal Lesions: Is It Time for Global Adoption?

Abstract

The majority of colon lesions are <10 mm in size and are easily resected by endoscopists with appropriate basic training. Lesions ≥10 mm in size are difficult to remove technically and are associated with higher rates of incomplete resection. Currently, the main endoscopic approaches include endoscopic mucosal resection (EMR) for lesions without submucosal invasion, and endoscopic submucosal dissection (ESD) for relatively larger lesions involving the superficial submucosal layer. Both of these approaches have limitations, EMR cannot reliably ensure complete resection for larger tumors and recurrence is a key limitation. ESD reliably provides complete resection and an accurate pathological diagnosis but is associated with risk such as perforation or bleeding. In addition, both EMR and ESD may be ineffective in treating subepithelial lesions that extend beyond the submucosa. Endoscopic full-thickness resection (EFTR) is an emerging innovative endoscopic therapy which was developed to overcome the limitations of EMR and ESD. Advantages include enabling a transmural resection, complete resection of complex colorectal lesions involving the mucosa to the muscularis propria. Recent studies comparing EFTR with current resection techniques and radical surgery for relatively complicated and larger lesion have provided promising results. If the current trajectory of research and development is maintained, EFTR will likely to become a strong contender as an alternative standard of care for advanced colonic lesions. In the current study we aimed to address this need, and highlighted the areas of future research, while stressing the need for multinational collaboration provide the steppingstone(s) needed to bring EFTR to the mainstream.

Safety and Efficacy of Exposed Endoscopic Full-thickness Resection for Colorectal Submucosal Tumors Originating from Muscularis Propria

“…There were no signi cant adverse events happened. Subsequently, many studies have suggested that nonexposed EFTR is safe and effective in the treatment of colorectal lesions, but the lesions involved in the study are mostly mucosal lesions, and there are only a few reports of submucosal tumors [11,19]. In our study, we demonstrated a total technical success rate of 100% for exposed EFTR on treatment of colorectal SMTs.…”

“…Considering that closed EFTR devices such as FTRD are not available in most of the endoscopy centers in China. And, in recent years, endoscopic suturing devices and technologies such as OTSC system, purse suture with clip and nylon rope have been proved to be effective in suturing of gastrointestinal wall defects [10,11]. In our study, we aimed to research the safety and e cacy of exposed EFTR in the treatment of colorectal SMTs through retrospective data analysis.…”

Endoscopic techniques for management of large colorectal polyps, strictures and leaks

“…Conversely, the non-exposed approach involves pinching off the lesion with a clip or sutures before resecting the lesion with a snare just above the clip or suture line. Common closure devices include endoclips for small (< 1 cm) defects and over-the-scope clips or Overstitch for larger defects [ 34 ]. An over the scope full thickness resection device that employs a clip over a large cap (Ovesco) with an embedded snare fitted on the tip of a colonoscope has been successfully used for resection of fibrotic polyps as well as those growing into a diverticulum or the appendiceal orifice [ 35 ] ( Image 9 ).…”