1676 EFTR as a Means for Complete Resection for Adenomas

Abstract

INTRODUCTION: Endoscopic full thickness resection (EFTR) is an alternative to Endoscopic Mucosal Resection (EMR) and Endoscopic Sub-mucosal Dissection (ESD) for non-lifting lesions or flat lesions and residual adenomas. The current guidelines dictate that any patient able to undergo endoscopic curative treatment should consider it as the first line it is safer and less costly while being equally effacious. Here we describe a case of a non-lifting lesion in the ascending colon at 22 millimeters (mm) of size whose resection was previously attempted by EMR. CASE DESCRIPTION/METHODS: 66-year-old male with a past medical history of CAD s/p CABG, hypertension, hyperlipidemia, liver cirrhosis and diabetes mellitus presented for surveillance colonoscopy. Three months prior to this he had a piece meal EMR of a 22 mm flat Tubulo-villous Adenoma in the proximal ascending colon. After this a Colonscope was passed under direct vision. EFTR device was passed and when it reached the proximal ascending colon, the previously placed tattoo was seen. A post-polypectomy scar was found between the tattoos. This was a non-lifting lesion and was granular lateral spreading and 22 mm in size. Thermal marking was placed and an Ovesco clip was now passed. Ovesco clip was deployed and using a snare within cap technique a full thickness resection of 22 mm was performed. DISCUSSION: ESD and EMR have enabled en bloc R0 curative interventions. FTRD is useful in situations where ESD and ESR fail to achieve a R0 resection. Recent study published by Kuellmer et al showed a technical success rate of 90% and a R0 resection rate of 77%. The limitation in terms of size is the most important one where the snare cannot be used as effectively for lesions more than 20 mm of size. Improvements in FTRD technology in regards to the snare size in the future will allow clinicians to pursue FTRD in these cases. We suggest close follow up for any patient who has a lesion resected on scar tissue due to the reoccurrence at sites where FTRD was done as was seen in the study published by Kuellmer et al.