Endoscopic full-thickness resection of the gastrointestinal tract using the FTRD system: experience from a single center

Czech version

Authors: S. Krautstenglová ¹; Alžběta Hujová ¹ ; M. Vašátko ¹; O. Fabián ² ; Peter Mačinga ¹ ; Tomáš Hucl ¹
Authors‘ workplace: Klinika hepatogastroenterologie, IKEM, Praha ¹; Pracoviště klinické a transplantační patologie, IKEM, Praha ²
Published in: Gastroent Hepatol 2026; 80(4): 314-320
Category: Clinical and Experimental Gastroenterology: Original Article
doi: https://doi.org/10.48095/ccgh2026314

Overview

Background: Endoscopic full-thickness resection (EFTR) has emerged as an effective minimally invasive treatment for selected gastrointestinal lesions not amenable to conventional endoscopic resection techniques. The aim of this study was to evaluate the efficacy and safety of EFTR using the Full-Thickness Resection Device (FTRD) at a tertiary referral center. Methods: We retrospectively analyzed all consecutive patients who underwent EFTR using the FTRD system between October 2016 and May 2026. Patient characteristics, lesion features, technical success, histopathological outcomes, adverse events, and follow-up colonoscopy findings were evaluated. Results: A total of 127 procedures were performed in 123 patients. Technical success was achieved in 89.0% of the procedures, while R0 resection was obtained in 66.9%. Procedure-related adverse events occurred in 12.6% of the cases. Two perforations required surgical revision; one was treated using OTSC. Follow-up colonoscopy demonstrated residual or recurrent lesions in 10.1% of the patients. Conclusion: EFTR using the FTRD system is an effective and safe treatment option for selected gastrointestinal lesions unsuitable for conventional endoscopic resection. Our results are comparable with published literature and emphasize the role of this technique in therapeutic endoscopy.

Keywords:

endoscopic full-thickness resection – FTRD – colorectal neoplasia – non-lifting lesion-subepithelial lesion – local residual neoplasia

Sources

1. Ferlitsch M, Hassan C, Bisschops R et al. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline –⁠ Update 2024. Endoscopy 2024; 56 (7): 516–545. doi: 10.1055/a-2304-3219.

2. Pimentel-Nunes P, Libânio D, Bastiaansen BA et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline –⁠ Update 2022. Endoscopy 2022; 54 (6): 591–622. doi: 10.1055/a-1811-7025.

3. Schmidt A, Beyna T, Schumacher B et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67 (7): 1280–1289. doi: 10.1136/gutjnl-2016-313677.

4. Meier B, Stritzke B, Kuellmer A et al. Efficacy and safety of endoscopic full-thickness resection in the colorectum: results from the German Colonic FTRD Registry. Am J Gastroenterol 2020; 115 (12): 1998–2006. doi: 10.14309/ajg.0000000000000795.

5. Fahmawi Y, Hanjar A, Ahmed Y et al. Efficacy and safety of full-thickness resection device for colorectal lesions: a systematic review and meta-analysis. J Clin Gastroenterol 2021; 55 (4): e27–e36. doi: 10.1097/MCG.0000000000001410.

6. Dolan RD, Bazarbashi AN, McCarty TR et al. Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis. Gastrointest Endosc. 2022; 95 (2): 216.e18–224.e18. doi: 10.1016/j.gie.2021.09.039.

7. McKechnie T, Govind S, Lee J et al. Endoscopic full-thickness resection for colorectal lesions: a systematic review and meta-analysis. J Surg Res 2022; 280 : 440–449. doi: 10.1016/j.jss.2022.07.019.

8. Wannhoff A, Meier B, Caca K. Systematic review and meta-analysis on effectiveness and safety of the full-thickness resection device in the colon. Z Gastroenterol 2022; 60 (5): 741–752. doi: 10.1055/a-1310-4320.

9. Kuellmer A, Mueller J, Caca K et al. Endoscopic full-thickness resection for early colorectal cancer. Gastrointest Endosc 2019; 89 (6): 1180.e1–1189.e1. doi: 10.1016/j.gie.2018.12.025.

10. Ichkhanian Y, Barawi M, Seifert H et al. Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience. Endoscopy 2022; 54 (1): 16–24. doi: 1 0.1055/a-1345-0044.

11. Obri M, Ichkhanian Y, Brown P et al. Full-thickness resection device for management of lesions involving the appendiceal orifice: systematic review and meta-analysis. Endosc Int Open 2023; 11 (9): E899–E907. doi: 10.1055/a-2131-4891.

12. Deprez PH, Moons LMG, O’Toole D et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54 (4): 412–429. doi: 10.1055/a-1751-5742.

13. Hassan C, Antonelli G, Dumonceau JM et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline –⁠ Update 2020. Endoscopy 2020; 52 (8): 687–700. doi: 10.1055/a-1185-3109.

14. Choe WH, Kim JH, Park JH et al. Long-term clinical outcomes of rectal neuroendocrine tumors according to the pathologic status after initial endoscopic resection: a KASID multi-center study. Am J Gastroenterol 2016; 111 (9): 1276–1282.

15. Brewer Gutierrez OI, Akshintala VS, Ichkhanian Y et al. Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis. Endosc Int Open 2020; 8 (3): E313–E325. doi: 10.1055/a-1073-7593.