Use of the full-thickness resection device (FTRD) to prevent bleeding after colonic polypectomy in a patient with a left ventricular assist device

Abstract

Background and study aims Treatment of colorectal polyps in patients undergoing permanent anticoagulation is associated with a significantly increased risk of peri-interventional bleeding. This specifically applies to polyps > 1 cm where endoscopic full-thickness resection (EFTR) with the full-thickness-resection device (FTRD) can be taken into consideration as an alternative approach to classical snare polypectomy. For these indications, EFTR appears to be superior to conventional techniques especially in terms of sufficient hemostasis due to the mechanical tissue compression achieved by the FTRDʼs integrated Over-The-Scope Clip (OTSC). This is demonstrated in the following case report of a 59-year-old male with a left ventricular assist device (LVAD) implanted due to congestive heart failure. He presented with intermittent hemorrhage from a large polyp in the ascending colon that was successfully treated via EFTR with the FTRD. A video is included.

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

“…For these reasons, in the Western world, ESD is mostly limited to expert centers [3]. EFTR has especially advanced management of complex colorectal precancerous and malignant lesions without lifting sign, e. g. due to scarring [14,15]. However, its applicability is practically limited to the lower gastrointestinal tract and its diameter is not appropriate for flat and spreading lesions, which are object of this study [16 -18].…”

Endoscopic Full Thickness Resection: A Systematic Review

“…EFTR has been used in other settings as anecdotal reports as in endoscopic transgastric fenestration for pancreatic walled off necrosis, EFTR of ectopic splenic nodules, EFTR of Dieulafoy's lesion and in special situations (post liver transplant scenario and on anticoagulation). 128 129 130 131 132…”

“…EFTR has been used in other settings as anecdotal reports as in endoscopic transgastric fenestration for pancreatic walled off necrosis, EFTR of ectopic splenic nodules, EFTR of Dieulafoy's lesion and in special situations (post liver transplant scenario and on anticoagulation). [128][129][130][131][132] Complications Apart from well-known complications of EFTR like perforation and bleeding (immediate or delayed), post-polypectomy syndrome, appendicitis (occlusion of appendicular orifice), 133 other unique adverse events have been described with EFTR. Overall complications occur in 12% of the patients.…”