Novel endoscopic full thickness resection device for colon polyp resection. These are our disclosures. Endoscopic full thickness resection, or EFTR, allows for the management of scarred and fibrotic lesions that are challenging to remove with endoscopic mucosal resection or endoscopic submucosal dissection. There are two main methods of performing EFTR, exposed and non-exposed EFTR. Exposed EFTR is where the lesion is resected, creating a temporary perforation prior to defect closure. Non-exposed EFTR is where the defect is effectively closed prior to the resection of the lesion, avoiding the temporary perforation. We present the first reported case of inhuman use of a novel non-exposed full thickness resection device. A 60-year-old man with a history of over 20 polyps, including three rectosigmoid polyps ranging from 4 to 6 centimeters that previously required endoscopic submucosal dissection, presents for endoscopic resection of a fourth rectosigmoid polyp adjacent to a previously resected polyp. Visible suture material in a cinch was seen at the site of prior endoscopic resection. A 20 millimeter sessile polyp was found next to this previously placed cinch. Given extensive scarring at the site due to the prior adjacent resection, the decision was made to pursue endoscopic full thickness resection. The polyp resection was successful using a novel full thickness resection device. This device includes an over-the-scope endoscopic clip and then uses a pre-loaded snare to resect the lesion, achieving non-exposed endoscopic full thickness resection. To set up the device, gently advance the colonoscope into the device cap until it stops. Next, remove the red safety cap. The device is now ready to be used. A 20 millimeter sessile polyp was seen in the sigmoid colon adjacent to a cinch at the site of a prior polyp resection. Endoscopic scissors were used to remove this previously placed cinch. Endoscopic scissors were used to remove this previously placed cinch. The lesion was then marked circumferentially using a marking probe. The device is mounted onto an endoscope and advanced to the sigmoid colon. Next, grasping forceps were used to grasp the lesion and pull it into the device cap. Note the preloaded snare and clip on the device. The clip was deployed and the lesion was snared using electrocautery. The specimen was successfully resected. The resection site was then examined. The clip was noted to be in appropriate position and a fatty patch was seen demonstrating full thickness resection. Pathology of the specimen showed a well differentiated invasive adenocarcinoma. The depth of submucosal invasion was 600 microns consistent with a T1B SM1 colon cancer. The deep and lateral margins were negative indicating an R0 resection. The novel full thickness resection device resulted in the successful resection of an invasive adenocarcinoma with negative margins. No adverse events occurred. There is plan for a follow-up colonoscopy in three to four months for a section of other polyps that were not resected during this procedure. This device could be a useful tool in the armamentarium for endoscopic resection of previously manipulated colon polyps and lesions with superficial submucosal invasion. Further, the ease of use of this device can allow for more generalized use and adoption for the management of these lesions. However, more studies are needed to validate the safety and efficacy of the device.

endoscopic full thickness resection

colon polyp removal

over-the-scope clip

invasive adenocarcinoma

scarred polyps