ASGE Advanced Endoscopic Lesion Resection Course (On-Demand) | 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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The document provides an overview of Endoscopic Full Thickness Resection (EFTR) and its applications. EFTR allows for full-thickness resection and diagnostic tissue acquisition by resecting all layers including the serosa. The technique involves using a device called the FTRD system, which includes an applicator cap with a mounted FTRD clip, an integrated HF monofilament snare and thread, and an endoscope sleeve with fixation tapes and an FTRD hand wheel. The document provides specific specifications for different applications of EFTR, such as colonic, diagnostic, and gastroduodenal procedures.<br /><br />The document also discusses the indications for EFTR, including non-lifting adenomas, early carcinomas, adenomas at difficult anatomic locations, and various gastrointestinal conditions. It highlights the factors that determine the success of EFTR, such as lesion size, colonic wall mobility, scarring, rigidity, and the volume of the lesion.<br /><br />Several studies are referenced to provide data on the success rates of EFTR in different scenarios. For example, one study showed that EFTR was successful in treating polyps involving the appendiceal orifice, with a high rate of technical and clinical success. Another study compared standalone FTR with hybrid EMR + FTR and found that hybrid procedures allowed for the resection of larger lesions. Other studies discussed the success of EFTR in treating suspected T1 colorectal cancers, colorectal lesions, upper lesions, and subepithelial gastric lesions.<br /><br />The document also mentions some potential adverse events associated with EFTR, such as bleeding and perforation, although the incidence of these events is relatively low. It emphasizes the importance of proper technique and optical control to minimize the risk of complications.<br /><br />Finally, a case is presented involving a patient with an appendiceal orifice polyp and a rectal mass. The plan includes performing EFTR for the polyp and further evaluation of the rectal mass using additional imaging techniques.<br /><br />Overall, the document provides an informative overview of EFTR and its applications, supported by relevant studies and a clinical case.

Keywords

Endoscopic Full Thickness Resection

EFTR

FTRD system

colonic procedures

gastroduodenal procedures

lesion size

success rates of EFTR

polyps involving appendiceal orifice

T1 colorectal cancers

adverse events of EFTR