Endoscopic Full-Thickness Resection of Subepithelial Lesions of the GI Tract

As techniques for endoscopic removal of large and subepithelial lesion of the gastrointestinal (GI) tract have evolved, the need for safe and effective methods for endoscopic full thickness resection (EFTR) has increased substantially. The most frequent indication for EFTR is for the removal of subepithelial lesions less than 5 cm in size originating from the muscularis propria (MP) layer of the GI tract. Present techniques for EFTR have arisen out of endoscopic submucosal dissection (ESD) and natural orifice transluminal endoscopic surgery (NOTES) methods and have evolved into free-hand EFTR techniques or device-assisted approaches. Devices for EFTR include the GERDX device, over-the-scope nitinol clips (OTSCs), and a modification of the OTSC, the full-thickness resection (FTR) device. In expert hands, EFTR provides effective complete en bloc resection of subepithelial lesions in the esophagus, stomach, and colon with a favorable adverse event profile.