Endoscopic full thickness resection may be an adequate approach in challenging situations such as lesion in the lower GI tract. This technique has the potential to spur surgical therapy in a subset of cases. The FTRD system is a tool for full thickness resection and diagnostic tissue acquisition. Malignant tumor metastasis to the colon has been observed to be extremely rare. The FTRD device consists of an applicator cap with a ready-to-use mounted FTRD clip, integrated snare, thread, and a hand wheel. For the application, first, insert the endoscope to the resection site, second, grasping and mobilizing the lesion, third, ensure the lesion is completely into the cap, and last, resect tissue and retrieve the specimen. Case Presentation This is a 65-year-old male with a personal history of metastatic melanoma of the rectum. Results post prior trans-anal full thickness decision and adjuvant therapy, presenting with hematochysia, was found to have a metastatic lesion at the rectosigmoid colon, presents for endoscopic evaluation and attempt full thickness endoscopic resection. After completing a full colonoscopy, a unexpected 10-millimeter C-cell mass, Paris 1S, was found at the descending colon. The mass was notable for melanocytic pigmentation, consisting with metastatic melanoma. Then we continue with marking the lesion. Continuing retrieval of the colonoscope, we encounter a second 10-millimeter C-cell mass with the same characteristics as previous lesion, consisting with metastatic melanoma. Because of abnormal mucosa surrounding the lesion, we proceed with biopsies for frozen section. Frozen sections were negative for tumor. EOS of the descending colon lesion shows a hypoechoic mass with well-defined borders, as suggesting invasion into the submucosa without extension into the muscularis propria. EOS of the rectosigmoid lesion shows a hypoechoic mass with well-defined borders, suggesting invasion only to the mucosa. Here we start the full thickness resection of the descending colon lesion. We grasp the lesion and pull into the cap. When all the lesion is into the cap, then we proceed with resection and then retrieval. This is the final appearance after full thickness resection. Then we proceed with the full thickness resection of the rectosigmoid lesion. We grasp the lesion and pull it into the cap. And when all the lesion is into the cap, then we proceed with resection and retrieval. This is the final appearance after full thickness resection. Then additional biopsies were taken from the deep margin of the resection defect. Final pathology report. Descending colon mass, metastatic melanoma, mucosal and deep margin free of tumor. Rectus invoi colon mass, metastatic melanoma, mucosal margin free of tumor. Endoscopic full thickness resection is a safe and effective minimally invasive treatment modality alternative to surgery or after failure of endostandar endoscopic resection. The FTRD is a viable and efficient tool to achieve a colonic full thickness resection in recurrent colorectal neoplasm related to previous surgical or endoscopic treatments. Malignant tumor metastatic to the colon are unusual. Learning points. Before undertaking major endoscopic resection, can consider frozen section if there is any doubts about the margin of deletion. Always perform a brief colonoscopy before undertaking major resection. As important clinically relevant findings may be present. Consider taking biopsies from the deep margin if you have any concerns about margins of the endoscopic full thickness resection specimen.

endoscopic full thickness resection

FTRD

lower gastrointestinal tract

metastatic melanoma

colorectal neoplasms