Over-the-scope clip-assisted endoscopic full thickness resection: a video-based case series

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Therapeutic gastrointestinal endoscopy has advanced from polypectomy to endoscopic full thickness resection (EFTR).
• Over-the-scope clip (OTSC)-assisted EFTR (OTSC-EFTR) enables endoscopists to manage challenging mucosal lesions.
• This technique mimics surgical principles, offering a safe, effective, and less demanding alternative.

Purpose of the Study:

• To report the single-center experience with OTSC-EFTR over one year.
• To evaluate the utility of OTSC-EFTR in managing difficult-to-resect gastrointestinal neoplasms.
• To assess the safety and efficacy of OTSC-EFTR for achieving complete tumor removal.

Main Methods:

• Video recording and analysis of 12 consecutive OTSC-EFTR cases.
• Focus on cases where conventional mucosal resection was insufficient.
• Inclusion of cases with deeper invasion, fibrosis, scarring, or appendiceal involvement.

Main Results:

• OTSC-EFTR proved effective in managing residual neoplastic tissue.
• Successful resection of lesions not amenable to conventional methods was demonstrated.
• Caution is advised for OTSC-EFTR at the ileocecal valve due to potential challenges.

Conclusions:

• OTSC-EFTR is a valuable tool for managing complex gastrointestinal mucosal neoplasms.
• A hybrid approach (piecemeal EMR followed by OTSC-EFTR) is proposed for larger colonic adenomas.
• Layered biopsy of the appendiceal stump post-EFTR is recommended to detect residual disease.