Endoscopic Full Thickness Resection: A Systematic Review
Background Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR. Methods A systematic literature...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2022-09-01
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| Series: | Journal of Digestive Endoscopy |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1755304 |
| _version_ | 1797995019028660224 |
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| author | Partha Pal Mohan Ramchandani Pradev Inavolu Duvvuru Nageshwar Reddy Manu Tandan |
| author_facet | Partha Pal Mohan Ramchandani Pradev Inavolu Duvvuru Nageshwar Reddy Manu Tandan |
| author_sort | Partha Pal |
| collection | DOAJ |
| description | Background Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR.
Methods A systematic literature search was performed using PubMed. All relevant original research articles involving EFTR were included for the review along with case report/series describing novel/rare techniques from 2001 to February 2022.
Results After screening 7,739 citations, finally 141 references were included. Non-exposed EFTR has lower probability of peritoneal contamination or tumor seeding compared with exposed EFTR. Among exposed EFTR, tunneled variety is associated with lower risk of peritoneal seeding or contamination compared with non-tunneled approach. Closure techniques involve though the scope (TTS) clips, loop and clips, over the scope clips (OTSC), full thickness resection device (FTRD), and endoscopic suturing/plicating/stapling devices. The indications of EFTR range from esophagus to rectum and include SELs arising from muscularis propria (MP), non-lifting adenoma, recurrent adenoma, and even early gastric cancer (EGC) or superficial colorectal carcinoma. Other indications include difficult locations (involving appendicular orifice or diverticulum) and full thickness biopsy for motility disorders. The main limitation of FTRD is feasibility in smaller lesions (<20–25 mm), which can be circumvented by hybrid EFTR techniques. Oncologic resection with lymphadencetomy for superficial GI malignancy can be accomplished by hybrid natural orifice transluminal endoscopic surgery (NOTES) combining EFTR and NOTES. Bleeding, perforation, appendicitis, enterocolonic fistula, FTRD malfunction, peritoneal tumor seeding, and contamination are among various adverse events. Post OTSC artifacts need to be differentiated from recurrent/residual lesions to avoid re-FTRD/surgery.
Conclusion EFTR is safe and effective therapeutic option for SELs, recurrent and non-lifting adenomas, tumors in difficult locations and selected cases of superficial GI carcinoma. |
| first_indexed | 2024-04-11T09:54:51Z |
| format | Article |
| id | doaj.art-46f29c65d6a543d8b5674f42699e2f38 |
| institution | Directory Open Access Journal |
| issn | 0976-5042 0976-5050 |
| language | English |
| last_indexed | 2024-04-11T09:54:51Z |
| publishDate | 2022-09-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Digestive Endoscopy |
| spelling | doaj.art-46f29c65d6a543d8b5674f42699e2f382022-12-22T04:30:38ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Digestive Endoscopy0976-50420976-50502022-09-01130315216910.1055/s-0042-1755304Endoscopic Full Thickness Resection: A Systematic ReviewPartha Pal0Mohan Ramchandani1Pradev Inavolu2Duvvuru Nageshwar Reddy3Manu Tandan4Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaBackground Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR. Methods A systematic literature search was performed using PubMed. All relevant original research articles involving EFTR were included for the review along with case report/series describing novel/rare techniques from 2001 to February 2022. Results After screening 7,739 citations, finally 141 references were included. Non-exposed EFTR has lower probability of peritoneal contamination or tumor seeding compared with exposed EFTR. Among exposed EFTR, tunneled variety is associated with lower risk of peritoneal seeding or contamination compared with non-tunneled approach. Closure techniques involve though the scope (TTS) clips, loop and clips, over the scope clips (OTSC), full thickness resection device (FTRD), and endoscopic suturing/plicating/stapling devices. The indications of EFTR range from esophagus to rectum and include SELs arising from muscularis propria (MP), non-lifting adenoma, recurrent adenoma, and even early gastric cancer (EGC) or superficial colorectal carcinoma. Other indications include difficult locations (involving appendicular orifice or diverticulum) and full thickness biopsy for motility disorders. The main limitation of FTRD is feasibility in smaller lesions (<20–25 mm), which can be circumvented by hybrid EFTR techniques. Oncologic resection with lymphadencetomy for superficial GI malignancy can be accomplished by hybrid natural orifice transluminal endoscopic surgery (NOTES) combining EFTR and NOTES. Bleeding, perforation, appendicitis, enterocolonic fistula, FTRD malfunction, peritoneal tumor seeding, and contamination are among various adverse events. Post OTSC artifacts need to be differentiated from recurrent/residual lesions to avoid re-FTRD/surgery. Conclusion EFTR is safe and effective therapeutic option for SELs, recurrent and non-lifting adenomas, tumors in difficult locations and selected cases of superficial GI carcinoma.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1755304endoscopic full thickness resectionfull thickness resection devicesub-epithelial lesionsover the scope clips |
| spellingShingle | Partha Pal Mohan Ramchandani Pradev Inavolu Duvvuru Nageshwar Reddy Manu Tandan Endoscopic Full Thickness Resection: A Systematic Review Journal of Digestive Endoscopy endoscopic full thickness resection full thickness resection device sub-epithelial lesions over the scope clips |
| title | Endoscopic Full Thickness Resection: A Systematic Review |
| title_full | Endoscopic Full Thickness Resection: A Systematic Review |
| title_fullStr | Endoscopic Full Thickness Resection: A Systematic Review |
| title_full_unstemmed | Endoscopic Full Thickness Resection: A Systematic Review |
| title_short | Endoscopic Full Thickness Resection: A Systematic Review |
| title_sort | endoscopic full thickness resection a systematic review |
| topic | endoscopic full thickness resection full thickness resection device sub-epithelial lesions over the scope clips |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1755304 |
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