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      Endoscopic Full-Thickness Resection of Colorectal Lesions with the New FTRD System: Single-Center Experience

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          Abstract

          Background and Aims: Endoscopic full-thickness resection (EFTR) is an emerging technique for the treatment of various conditions for which classic endoscopic resection techniques have failed or were considered to be at high risk for perforation. The full-thickness resection device (FTRD) is an over-the-scope system which allows a single-step EFTR. The aim of our study is to describe our experience in EFTR of colorectal lesions using the FTRD. Methods: Nine patients (10 colorectal lesions) were proposed for EFTR. Safety, R0 resection and endoscopic treatment success were evaluated. Results: Reasons for referral included nonlifting adenomas ( n = 4), nonlifting adenoma recurrence ( n = 5), and submucosal lesion ( n = 1). EFTR was technically successful in all patients. The mean duration of the procedure was 55 min. R0 resection was obtained in all patients. No major complications were detected. All lesions were successfully treated by the endoscopic technique and no patient was referred for surgery. In patients with available follow-up ( n = 6), no recurrence was detected. Conclusions: EFTR is a feasible, reasonable time-consuming, safe, and promising endoscopic resection technique. Key Messages: FTRD is an additional tool for difficult-to-treat colorectal lesions.

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          Most cited references20

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          The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.

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            JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection.

            Colorectal endoscopic submucosal dissection (ESD) has become common in recent years. Suitable lesions for endoscopic treatment include not only early colorectal carcinomas but also many types of precarcinomatous adenomas. It is important to establish practical guidelines in which the preoperative diagnosis of colorectal neoplasia and the selection of endoscopic treatment procedures are properly outlined, and to ensure that the actual endoscopic treatment is useful and safe in general hospitals when carried out in accordance with the guidelines. In cooperation with the Japanese Society for Cancer of the Colon and Rectum, the Japanese Society of Coloproctology, and the Japanese Society of Gastroenterology, the Japan Gastroenterological Endoscopy Society has recently compiled a set of colorectal ESD/endoscopic mucosal resection (EMR) guidelines using evidence-based methods. The guidelines focus on the diagnostic and therapeutic strategies and caveat before, during, and after ESD/EMR and, in this regard, exclude the specific procedures, types and proper use of instruments, devices, and drugs. Although eight areas, ranging from indication to pathology, were originally planned for inclusion in these guidelines, evidence was scarce in each area. Therefore, grades of recommendation were determined largely through expert consensus in these areas.
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              The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon

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                Author and article information

                Journal
                PJG
                PJG
                10.1159/issn.2387-1954
                GE - Portuguese Journal of Gastroenterology
                S. Karger AG
                2341-4545
                2387-1954
                2019
                July 2019
                17 December 2018
                : 26
                : 4
                : 235-241
                Affiliations
                [_a] aGastroenterology Department, Instituto Português de Oncologia de Lisboa Dr. Francisco Gentil, EPE, Lisbon, Portugal
                [_b] bPathology Department, Instituto Português de Oncologia de Lisboa Dr. Francisco Gentil, EPE, Lisbon, Portugal
                Author notes
                *Susana Mão de-Ferro, Serviço de Gastrenterologia, Instituto Português de Oncologia Dr. Francisco Gentil, EPE, Rua Prof. Lima Basto, PT–1099–023 Lisbon (Portugal), E-Mail smaodeferro@gmail.com
                Author information
                https://orcid.org/0000-0001-7551-1591
                Article
                493808 PMC6624659 GE Port J Gastroenterol 2019;26:235–241
                10.1159/000493808
                PMC6624659
                31328137
                6430e5d7-2856-4bbf-9cd4-48e02970b227
                © 2018 Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 04 July 2018
                : 14 September 2018
                Page count
                Figures: 3, Tables: 1, Pages: 7
                Categories
                Original Article

                Oncology & Radiotherapy,Gastroenterology & Hepatology,Surgery,Nutrition & Dietetics,Internal medicine
                Colorectal adenomas,Full-thickness resection,Nonlifting lesions

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