ASGE Advanced Endoscopic Lesion Resection Course | November 2022-5 Jamil An overview of Endoscopic Full Thickness Resection EFTR

5 Jamil An overview of Endoscopic Full Thickness Resection EFTR

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Endoscopic Full Thickness Resection (EFTR) is a technique that allows for complete resection of all layers of tissue, including the serosa, and enables diagnostic tissue acquisition. The procedure involves using a device called FTRD, which includes an applicator cap with a mounted clip, an HF monofilament snare, and an endoscope sleeve with fixation tapes and a hand wheel. The technique is used for various indications, including non-lifting adenomas, early carcinomas, difficult anatomical locations, and certain gastrointestinal conditions.<br /><br />The success of EFTR depends on factors such as the ability to capture the target lesion within the cap, the size of the lesion, colonic wall mobility, scarring, rigidity, and volume. Lesions larger than 20 mm with scarring or malignancy may not be suitable for EFTR.<br /><br />Studies have shown that EFTR is effective for resecting colonic lesions, suspected T1 colorectal cancers, upper gastrointestinal lesions, and subepithelial gastric lesions. The technical success and R0 resection rates for these procedures range from around 80% to over 90%. However, there are potential adverse events associated with EFTR, including bleeding and perforation, although the rates of these complications are relatively low.<br /><br />In a case example, a patient with an 8 mm polyp on the appendiceal orifice and an 18 mm rectal mass underwent EFTR for the polyp and further evaluation for the rectal mass. The procedure was successful in removing the polyp, which was found to have high-grade dysplasia. The evaluation for the rectal mass was ongoing with additional imaging and tests.<br /><br />In summary, EFTR is a promising technique for the resection of gastrointestinal lesions, offering the possibility of complete removal and diagnostic tissue acquisition. It is associated with high success rates and low rates of adverse events. However, careful patient selection and appropriate technique are crucial for optimal outcomes.

Keywords

Endoscopic Full Thickness Resection

EFTR

tissue resection

FTRD

diagnostic tissue acquisition

non-lifting adenomas

early carcinomas

gastrointestinal conditions

colonic lesions

adverse events