Endoscopic Full-Thickness Resection

Abstract

Flexible endoscopy was originally developed to examine and treat lesions originating from mucosal layer of gastrointestinal (GI) tract wall and located inside the lumen of hollow GI tract. Improvement in flexible endoscopes and development of new endoscopic accessories created a new endoscopic specialty—natural orifice translumenal endoscopic surgery (NOTES). Full-thickness resection of GI tract lesions is possibly one of the most promising directions in NOTES procedures. Endoscopic full-thickness resection of GI tract lesions can be done in three possible ways: via a submucosal tunnel separating the exit from GI tract lumen and the entrance into mediastinal or peritoneal cavity; the “closed” technique, allowing full-thickness resection of GI tract lesions without entering the peritoneal cavity; and the “open” technique, requiring full-thickness resection of the lesion with subsequent transmural closure of the GI tract wall defect. The OverStitch™ (Apollo EndoSurgery, Austin, TX) endoscopic suturing device allows reliable, surgical quality closure of inadvertent (perforations) and intentional (full-thickness resection) defects after endoscopic removal of GI tract lesions and truly serves as enabling technology for future NOTES procedures.