Clin Endosc.  2018 Jan;51(1):103-108. 10.5946/ce.2017.093.

Full-Thickness Resection Device for Complex Colorectal Lesions in High-Risk Patients as a Last-Resort Endoscopic Treatment: Initial Clinical Experience and Review of the Current Literature

• Wedi E
• Orlandini
• Gromski M
• Jung CF
• Tchoumak I
• Boucher S
• Ellenrieder V
• Hochberger J

• KMID: 2403641
• DOI: http://doi.org/10.5946/ce.2017.093

Abstract

The full-thickness resection device (FTRD) is a novel endoscopic device approved for the resection of colorectal lesions. This case-series describes the device and its use in high-risk patients with colorectal lesions and provides an overview of the potential indications in recently published data. Between December 2014 and September 2015, 3 patients underwent endoscopic full thickness resection using the FTRD for colorectal lesions: 1 case for a T1 adenocarcinoma in the region of a surgical anastomosis after recto-sigmoidectomy, 1 case for a non-lifting colonic adenoma with low-grade dysplasia in an 89-year old patient and 1 for a recurrent adenoma with high-grade dysplasia in a young patient with ulcerative rectocolitis who was under immunosuppression after renal transplantation. Both technical and clinical success rates were achieved in all cases. The size of removed lesions ranged from 9 to 30 mm. Overall, the most frequent indication in the literature has been for lifting or non-lifting adenoma, submucosal tumors, neuroendocrin tumors, incomplete endoscopic resection (R1) or T1 carcinoma. Colorectal FTRD is a feasible technique for the treatment of colorectal lesions and represents a minimally invasive alternative for either surgical or conventional endoscopic resection strategies.

Keyword

Colonoscopy; Colorectal neoplasms; Full-thickness resection device; Over-the-scope-clip

MeSH Terms

Adenocarcinoma
Adenoma
Anastomosis, Surgical
Colon
Colonoscopy
Colorectal Neoplasms
Humans
Immunosuppression
Kidney Transplantation
Lifting
Proctocolitis

Figure

• 

  Fig. 1. Step by step description of the full-thickness resection device (FTRD) technique. (A) Components of the FTRD system: the cap, the grasper and the snare. (B) Grasping the lesion with the FTRD grasper. (C) Retrieval of the target tissue into the cap. (D) Release of the over-the-scope-clip. (E) Closure.

• 

  Fig. 2. Case 1: Magnetic resonance imaging (MRI) and endoscopic images. (A) Coronal MRI image, demonstrating local recurrent rectal adenocarcinoma, without muscle layer infiltration. (B) Pre-markage of the lesion with a 1.5 mm Flush knife (Fujifilm, Tokyo, Japan) using the coagulation setting. (C) Lesion after over-the-scopeclip deployment. (D) Aspect of the mucosa after resection. (E) Resected lesion. (F) Endoscopic view at a follow-up colonoscopy, 15 months status-post endoscopic resection.

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