Endoscopic full-thickness resection of early mucosal neoplasms

Abstract

Endoscopic full-thickness resection is a new resection technique that expands the possibilities of endoscopic resection. It is best evaluated for the resection of early mucosal neoplasms in the colorectum but can also be used in the upper gastrointestinal tract. In particular, it enables endoscopic resection in cases of so-called difficult adenomas in the colorectum. This includes resection of nonlifting adenomas and adenomas at difficult locations. Endoscopic full-thickness resection could help avoid surgery in these cases. The Full-Thickness Resection Device is the best-studied system thus far. It has high efficiency and low rate of complication for resection of difficult adenomas. Alternatively, snare resection above a previously-applied clip provides an additional method for endoscopic full-thickness resection. Both techniques have successfully been evaluated in the upper gastrointestinal tract, especially for resection of duodenal adenomas. For the resection of early gastric cancer, combined endoscopic and laparoscopic approaches might offer an alternative treatment for lesions that are not suitable for endoscopic resection alone.