Endoscopic full-thickness GI wall resection: current status

Abstract

Endoscopic full-thickness resection (EFR) of gastric and colonic wall lesions may obviate the need for surgery in patients with benign and endoscopically treatable malignant lesions, such as large, sessile polyps or early cancer. Full-thickness resection may replace piecemeal resection as a procedure of preference and may benefit the histopathologic diagnosis with regard to resection margins and depth of invasion. During the last decade, a large volume of research in this field, both preclinical and clinical, has been reported in the literature. In accordance with the trend of minimally invasive procedures and endoluminal approaches, the currently practiced technologies enable and support advances in the experimental work toward EFR of the GI wall. 1 Ramirez J.M. Aguilella V. Gracia J.A. et al. Local full-thickness excision as first line treatment for sessile rectal adenomas: long-term results. Ann Surg. 2009; 249: 225-228 Crossref PubMed Scopus (44) Google Scholar , 2 Kalloo A.N. Singh V.K. Jagannath S.B. et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004; 60: 114-117 Abstract Full Text Full Text PDF PubMed Scopus (1155) Google Scholar , 3 Sclabas G.M. Swain P. Swanstrom L.L. Endoluminal methods for gastrotomy closure in natural orifice transenteric surgery (NOTES). Surg Innov. 2006; 13: 23-30 Crossref PubMed Scopus (140) Google Scholar , 4 Pasricha P.J. Krummel T.M. NOTES and other emerging trends in gastrointestinal endoscopy and surgery: the change that we need and the change that is real. Am J Gastroenterol. 2009; 104: 2384-2386 Crossref PubMed Scopus (11) Google Scholar Unlike full-thickness resection of extraperitoneal lesions, resection of intraperitoneal lesions obviously always requires leakage-proof closure of the defect. Colonic and gastric walls differ in many aspects, but it appears that common considerations have guided the research and development efforts for both parts of the GI tract. The aim of this review is to summarize the current status of this therapeutic trend, to define the major challenges involved, and to evaluate its future potential and serve as the basic reference for future developments in this direction.