Role of non-exposed endoscopic full thickness resection in the gastrointestinal tract

Endoscopic full-thickness resection (EFTR) has emerged as an innovative approach for the management of complex gastrointestinal lesions not amenable to conventional endoscopic techniques. EFTR enables en bloc transmural resection with reliable defect closure, achieving high R₀ resection rates in non-lifting colorectal adenomas, subepithelial tumors, and selected early T₁ cancers. The technique offers a minimally invasive alternative to surgical intervention in appropriately selected cases. Technical failure and adverse event rates remain low when evidence-based patient and lesion selection criteria are considered. Structured training may further reduce technical failure rates. Ongoing studies will further clarify the role of EFTR and hybrid approaches in therapeutic endoscopy. This practice-oriented review presents the current evidence on the clinical efficacy, safety, and technical advances associated with EFTR, with a focus on non-exposed EFTR and the Full-Thickness Resection Device (FTRD).