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Endoscopic Full-Thickness Resection for Colorectal Neoplasm: Current Status and Future Directions

  • Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of Review

Endoscopic submucosal dissection (ESD) is recognized as a minimally invasive treatment for colorectal cancer. However, colorectal ESD has not been internationally accepted as a first-line therapeutic option due to technical difficulties and high complication rates. Non-lifting tumors present a further limitation of ESD. Colorectal endoscopic full-thickness resection (eFTR) with over-the-scope clips (OTSCs) shows great potential in patients for whom ESD is not possible and also for those who might have ESD-related complications. The present manuscript aims to discuss the complementary role of eFTR using OTSCs and the future development of eFTR with a novel suturing device.

Recent Findings

Colorectal eFTR is feasible and has acceptable en bloc and R0 resection rates and procedure-related adverse events. This technique is primarily used for non-lifting and recurrent adenomas, especially in lesions ≤ 2 cm. This approach offers the potential to decrease the postoperative morbidity and mortality associated with segmental colectomy while enhancing the diagnostic yield compared to that of current endoscopic techniques.

Summary

eFTR using OTSCs is a safe and effective procedure for treating colorectal non-lifting and recurrent adenoma. The indications may be expanded to include subepithelial tumors, carcinoid tumors, and neuromuscular GI disorders. eFTR using OTSCs is not recommended for large lesions (> 30 mm), but innovative methods and new devices for eFTR and suturing will overcome the limitations by allowing minimally invasive surgery for colorectal cancer in the near future.

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Abbreviations

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

GI:

Gastrointestinal

OTS:

Over-the-scope

OTSC:

Over-the-scope clip

FTRD:

Full-thickness resection device

eFTR:

Endoscopic full-thickness resection

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Acknowledgements

This article is dedicated to the memory of Dr. Hirohito Mori, Dr. Hideki Kobara, and Dr. Noriko Nishiyama who were our teachers and role models. They were always the first to try innovative ideas and inspired those around them to never stop challenging themselves.

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Authors and Affiliations

  1. Department of Gastroenterology, Kagawa Rosai Hospital, 3-3-1, Joutou, Marugame, Kagawa, Japan

    Shintaro Fujihara & Akira Yoshitake

  2. Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan

    Hirohito Mori, Hideki Kobara, Noriko Nishiyama & Tsutomu Masaki

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  1. Shintaro Fujihara
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  2. Hirohito Mori
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  3. Hideki Kobara
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  4. Noriko Nishiyama
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Correspondence to Shintaro Fujihara.

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Fujihara, S., Mori, H., Kobara, H. et al. Endoscopic Full-Thickness Resection for Colorectal Neoplasm: Current Status and Future Directions. Curr Colorectal Cancer Rep 14, 22–30 (2018). https://doi.org/10.1007/s11888-018-0399-4

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