Full-Thickness Resection Device for Complex Colorectal Lesions in High-Risk Patients as a Last-Resort Endoscopic Treatment: Initial Clinical Experience and Review of the Current Literature

Wedi, Edris; Orlandini, Beatrice; Gromski, Mark A.; Jung, Carlo; Tchoumak, Irina; Boucher, Stephanie; Ellenrieder, Volker; Hochberger, J.

doi:10.5946/ce.2017.093

Cited by 26 publications

(18 citation statements)

References 14 publications

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“…Meeting the mentioned requirements, classical EMR technique can be improved with a new external additional working channel (AWC, Ovesco Endoscopy, Tuebingen, Germany) that was recently introduced and termed "EMR+ technique" [10]. To this end, the AWC is mounted on a standard endoscope similar to the setup used with the full-thickness resection device (FTRD) [11].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic mucosal resection with an additional working channel (EMR+) in a porcine ex vivo model: a novel technique to improve en bloc resection rate of snare polypectomy

et al. 2020

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Background and study aims Recently, a new external additional working channel (AWC) was introduced by which conventional endoscopic mucosal resection (EMR) can be improved to a technique termed “EMR+”. We first evaluated this novel technique in comparison to classical EMR in flat lesions. Methods The trial was prospectively conducted in an ex vivo animal model with porcine stomachs placed into the EASIE-R simulator. Prior to intervention, standardized lesions were set by coagulation dots, measuring 1, 2, 3 or 4 cm. Results Overall, 152 procedures were performed. EMR and EMR+ were both very reliable in 1-cm lesions, each showing en bloc resection rates of 100 %. EMR+ en bloc resection rate was significantly higher in 2-cm lesions (95.44 % vs. 54.55 %, P = 0.02), in 3-cm lesions (86.36 % vs. 18.18 %, P < 0.01) and also in 4-cm lesions (60.00 % vs. 0 %, P < 0.01). Perforations occurred only in EMR+ procedures in 4-cm lesions (3 of 20; 15 %). Conclusions With its grasp-and-snare technique, EMR+ facilitates en bloc resection of larger lesions compared to conventional EMR. In lesions 2 cm and larger, EMR+ has demonstrated advantages, especially concerning en bloc resection rate. At 3 cm, EMR+ reaches its best discriminatory power whereas EMR+ has inherent limits at 4 cm and in lesions of that size, other techniques such as ESD or surgery should be considered.

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Section: Introductionmentioning

confidence: 99%

Endoscopic mucosal resection with an additional working channel (EMR+) in a porcine ex vivo model: a novel technique to improve en bloc resection rate of snare polypectomy

et al. 2020

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“…In some centers, EMR or ESD of the ulcer at the resection site is considered to determine if residual neoplasia is present at the resection site. The availability of the endoscopic full thickness resection device for use in the colon, 43,44 may increase the use of endoscopic full thickness resection as adjuvant therapy after standard endoscopic resection of malignant polyps in the colon. The morbidity of rectal surgery is higher than colonic surgery, and includes the risk of sexual dysfunction and low anterior syndrome.…”

Section: Advising the Patient After Endoscopic Resection Of A Malignamentioning

confidence: 99%

Optimal Management of Malignant Polyps, From Endoscopic Assessment and Resection to Decisions About Surgery

Rex

Shaukat

Wallace

2019

Clinical Gastroenterology and Hepatology

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Colorectal cancer is defined clinically as invasion of dysplastic cells into the submucosa. Lesions with submucosal invasion but without invasion into the muscularis propria are generally called malignant polyps. A stepwise approach produces optimal management of malignant polyps (including polypoid and flat/depressed lesions). The first step is to avoid endoscopic resection of nonpedunculated lesions with endoscopic features that predict deep submucosal invasion. Lesions without such features are candidates for endoscopic resection. The second step is to assess candidates for endoscopic resection for features that predict an increased risk of superficial submucosal invasion. Such lesions should be considered for en bloc endoscopic excision if feasible. The third step is giving patients with endoscopically resected malignant polyps good advice regarding whether to undergo adjuvant therapy, usually surgery. We review the endoscopic and histologic criteria that guide clinicians through these steps.

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“…Perforation is prevented by the clip. FTR can also be done with the recently developed FTR Device (FTRD), which combines these two steps [59]. Further development and application of this technique is expected.…”

Section: Clipping In Ftrmentioning

confidence: 99%

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

Turan

Ultee

Geenen

et al. 2019

Expert Review of Medical Devices

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Introduction: The most commonly used treatment for advanced colorectal adenomas is endoscopic mucosal resection (EMR). The increased number of EMRs since the introduction of the screening program for colorectal cancer has resulted in an increase in EMR-related complications. This review summarizes the current knowledge for the use of clips for the treatment and prevention of complications after EMR. Areas covered: The historical development of clips is summarized and their properties are evaluated. An overview is presented of the evidence for therapeutic and prophylactic clipping for bleeding or perforation after EMR in the colon. Several clipping techniques are discussed in relation to the efficacy of wound closure. Furthermore, new techniques that will likely influence the use of clips in the future endoscopic practice, such as endoscopic full-thickness resection (eFTR) are also highlighted. Expert commentary: Most research focuses on prophylactic clipping for delayed bleeding after EMR of large adenomas. We advocate a distance of 0.5-1.0 cm between aligning clips. This focus may likely shift from bleeding to perforation. Here, endoscopic treatment with through-the-scope clips and largediameter clips may well replace surgery. The future role of clips will also depend on the further development of new endoscopic technologies, such as eFTR.

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Full-Thickness Resection Device for Complex Colorectal Lesions in High-Risk Patients as a Last-Resort Endoscopic Treatment: Initial Clinical Experience and Review of the Current Literature

Cited by 26 publications

References 14 publications

Endoscopic mucosal resection with an additional working channel (EMR+) in a porcine ex vivo model: a novel technique to improve en bloc resection rate of snare polypectomy

Endoscopic mucosal resection with an additional working channel (EMR+) in a porcine ex vivo model: a novel technique to improve en bloc resection rate of snare polypectomy

Optimal Management of Malignant Polyps, From Endoscopic Assessment and Resection to Decisions About Surgery

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

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