title: Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience.
abstract: OBJECTIVE
  Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract may be a valuable therapeutic and diagnostic approach for a variety of indications. Although feasibility of EFTR has been demonstrated, there is a lack of safe and effective endoscopic devices for routine use. The aim of this study was to investigate the efficacy and safety of a novel over-the-scope device for colorectal EFTR.
  
  
  METHODS
  Between July 2012 and July 2014, 25 patients underwent EFTR at two tertiary referral centers. All resections were performed using the full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Data were collected retrospectively.
  
  
  RESULTS
  Indications for EFTR were: recurrent or incompletely resected adenoma with nonlifting sign (n = 11), untreated adenoma and nonlifting sign (n = 2), adenoma involving the appendix (n = 5), flat adenoma in a patient with coagulopathy (n = 1), diagnostic re-resection after incomplete resection of a T1 carcinoma (n = 2), adenoma involving a diverticulum (n = 1), submucosal tumor (n = 2), and diagnostic resection in a patient with suspected Hirschsprung's disease (n = 1). In one patient, the lesion could not be reached because of a sigmoid stenosis. In the other patients, resection of the lesion was macroscopically complete and en bloc in 20/24 patients (83.3 %). The mean diameter of the resection specimen was 24 mm (range 12 - 40 mm). The R0 resection rate was 75.0 % (18/24), and full-thickness resection was histologically confirmed in 87.5 %. No perforations or major bleeding were observed during or after resection. Two patients developed postpolypectomy syndrome, which was managed with antibiotic therapy.
  
  
  CONCLUSIONS
  Full-thickness resection in the lower gastrointestinal tract with the novel FTRD was feasible and effective. Prospective studies are needed to further evaluate the device and technique.
authors.affiliation: Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Arthur
authors.initials: A
authors.lastname: Schmidt
authors.affiliation: Department of Gastroenterology and Hepatology, Zürich, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Bauerfeind
authors.affiliation: Department of Gastroenterology and Hepatology, Zürich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Gubler
authors.affiliation: Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Damm
authors.affiliation: Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Bauder
authors.affiliation: Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Karel
authors.initials: K
authors.lastname: Caca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000295:instrumentation*; D003106:Colon / Q000601:surgery*; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome