The document reviews current techniques and devices used for EFTR, clinical applications and outcomes.
The Technology Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared an ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection, aiming to review current techniques and devices used for EFTR and to review clinical applications and outcomes. The document also contains a number of links to videos illustrating different techniques of exposed and non-exposed EFTR.
The authors state that with the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic alternative to surgical resection for the treatment of subepithelial tumors that involve the muscularis propria and for epithelial neoplasia with significant fibrosis.
EFTR techniques are classified in two groups: “exposed” and “non-exposed” EFTR. In exposed EFTR, the full-thickness resection is undertaken first, with subsequent closure of the defect, the temporary exposure of the peritoneal cavity to the intestinal lumen being the basis for the term “exposed”. Further classification of the exposed techniques is made into tunneled and non-tunneled techniques. In non-exposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion.
Ovesco’s FTRD as the first FDA-cleared device for non-exposed EFTR in the colon is described with detailed technical data, a video illustration and a summary of some studies evaluating the device. A few studies directly comparing different resection and closure techniques are also presented.
The authors summarize that exposed and non-exposed EFTR techniques are emerging as less invasive alternatives to surgical resection of subepithelial tumors that involve the muscularis propria or mucosal neoplasia with associated fibrosis. However, the degree to which endoscopic resection can be used in place of oncologic surgical resection remains to be determined by additional data on variable lesion types, sizes, locations, and stages evaluated in future studies. Continued refinement of techniques and dedicated tools may expand the use of EFTR and make it accessible to more endoscopists.
ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection
Aslanian HR, Sethi A, Bhutani MS, Goodman AJ, Krishnan K, Lichtenstein DR, Melson J, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sullivan SA, Thosani N, Trikudanathan G, Trindade AJ, Watson RR, Maple JT for the ASGE Technology Committee
VideoGIE. 2019 Jun 29;4(8):343-350. doi:10.1016/j.vgie.2019.03.010.