Endoscopic Full-Thickness Resection (EFTR) - Polyp Resection Techniques

Technique:

 • Planned resection margins marked thermally. The full-thickness resection device (FTRD) system is placed onto the colonoscope. The polyp is grasped and slowly pulled into a cap loaded with a modified over-the-scope clip. The clip is deployed followed by closure of a preloaded snare at the tip of the cap, and the tissue is cut with electrocautery.

Indications:

 • En bloc resection for non-lifting mucosal polyps (scarred or polyps with deep submucosal invasion) or submucosal tumors

 • Polyps in difficult anatomic locations

Limitations:

 • Advancing the FTRD mounted colonoscope to the cecum can be challenging for proximal lesions

 • Difficult to achieve en bloc resection for lesions mm

 • Tissue must be pulled into cap rather than suctioned, to avoid injury of extracolonic structures; more fibrotic areas may therefor be challenging

 • Steps must be performed in rapid sequence to avoid losing grasp of tissue between deploying the clip and closing the snare

 • Delayed adverse events may still occur despite adequate clip closure



Dr. Enrik Aguila @enrrikke



#Endoscopic #Full #Thickness #EFTR #Polyp #Resection #Management #gastroenterology