Recent advances and current challenges in endoscopic resection with the full-thickness resection device

Mun, Elijah J.; Wagh, Mihir S.

doi:10.3748/wjg.v29.i25.4009

Cited by 4 publications

(1 citation statement)

References 46 publications

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“…In conclusion, we conducted the first multicentre study showing that unpredictable technical issues can complicate EFTR procedure and must be considered in all cases, despite the recognized safety profile [29]. The proposal for a classification is to invite all endoscopists who perform this procedure to share a single language and merge data from national registries.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Gibiino,

Binda,

Papparella

et al. 2024

Endoscopy

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Background: Endoscopic full-thickness resection (EFTR) is an effective and safe technique for non-lifting colorectal lesions. Technical issues or failures with full-thickness resection device (FTRD) system are reported but there are no data about their details. The aim of our study was to quantify and classify FTRD technical failures. Patients and methods: We performed a retrospective study involving 17 Italian centres with experience in advanced resection techniques and OVESCO devices. Each centre shared and classified all the consecutive failures prospectively collected during colorectal EFTR by using FTRD from 2018 to 2022. Primary outcome was technical failure rate and classification; secondary outcomes included management, clinical success, and complications’ assessment in this population. Results: Included lesions were mainly recurrent (52%), with mean dimension of 18.4 (± 7.5) mm. Among 750 EFTRs, failures occurred in 77 patients (35 F, mean age 68.9 ±8.9 years). A classification was proposed in type I snare uncutting (53.2%), type II clip misdeployment (31.2%) and type III cap misplacement (15.6%). Among endoscopic treatment completed, rescue EMR was performed in 57 patients (79%), allowing en-bloc and R0 resection in 71% and 64% cases, respectively. Overall adverse events rate was 27.3%. Pooled estimates for the rate of failure, complications and rescue endoscopic therapy were similar between low- and high-volume centres (p=0.08, p = 0.702 and p= 0.713). Conclusions: Colorectal EFTR with FTRD is a challenging technique with a not negligible rate of technical failure and complications. Experience in rescue resection techniques and multidisciplinary management are mandatory in this setting.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Gibiino,

Binda,

Papparella

et al. 2024

Endoscopy

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Amphiphilic Gelator‐Based Shear‐Thinning Hydrogel for Minimally Invasive Delivery via Endoscopy Catheter to Remove Gastrointestinal Polyps

Dave,

Vithalani,

Singh

et al. 2024

Small

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Injectable polymeric hydrogels delivered via endoscopic catheter have emerged as promising submucosal agents, offering durable, long‐lasting cushions to enhance the efficacy of endoscopic submucosal dissection (ESD) for the removal of small, flat polyps from the gastrointestinal tract (GIT). However, polymer‐based injections do not meet the easy‐injectability criteria via catheter because their high viscosity tends to clog the catheter needle. To the best of knowledge, for the first time, report the fabrication of an amphiphile‐based small molecule hydrogel of diglycerol monostearate (DGMS) that self‐assembles to form hydrogel (DGMSH) for delivery via an endoscopic catheter. Physicochemical characterization of the hydrogel reveals its fibrous morphology, shear‐thinning behaviour, and easy injectability, along with its scalability and long shelf‐life (6 months). Ex vivo studies on the goat's stomach and intestine demonstrate the ease of injectability through the catheters and the development of visible submucosal cushion depots with the desired height. Moreover, the hydrogel can encapsulate both hydrophobic and hydrophilic drugs/dyes. In vivo studies in small animals have found that the hydrogel depot is durable, biocompatible, non‐immunogenic, and has a hemostatic effect. Endoscopic studies in the porcine model demonstrate a safe injection and endoscopic excision of GI polyps acting as a suitable agent for ESD.

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Advances in Endoscopic Resection

Esaki,

Mohapatra,

Fukami

2024

Gastroenterology Clinics of North America

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Recent advances and current challenges in endoscopic resection with the full-thickness resection device

Cited by 4 publications

References 46 publications

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Amphiphilic Gelator‐Based Shear‐Thinning Hydrogel for Minimally Invasive Delivery via Endoscopy Catheter to Remove Gastrointestinal Polyps

Advances in Endoscopic Resection

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