Endoscopic full-thickness resection: Current status

Figure 1 Endoscopic full-thickness resection with prior transmural suturing. A: Transmural sutures are placed underneath a subepithelial tumor (schematic illustration); B: The sutures are securing gastric wall patency after full-thickness resection; C: The GERDX^TM device (G-Surg, Seeon, Germany); D: The tip of GERDX^TM device with opened branches and the central tissue retractor.

Figure 2 Endoscopic full-thickness resection of a gastric gastrointestinal stromal tumors after prior transmural suturing. A: Endoscopic image of the subepithelial tumor in the gastric corpus; B: EUS-image showing an inhomogeneous tumor arising from the muscularis propria; C: Two transmural sutures are deployed underneath the tumor using the PlicatorTM suturing device; D: EUS image after suturing. The PTFE pledges are indicated with arrows; E: Resection site. The transmural sutures are securing gastric wall patency; F: EUS image of the resection site. The PTFE pledges are indicated with arrows. EUS: Endoscopic ultrasonography.

Figure 3 Full thickness resection device (Ovesco Endoscopy, Tuebingen, Germany). A: Tip of a colonoscope with the mounted FTRD. A grasping forceps is advanced through the working channel of the scope; B: The assembled FTRD on a colonoscopy. FTRD: Full thickness resection device.

Figure 4 Schematic image of the resection procedure with the full-thickness resection device. A: The lesion is grasped with a forceps and pulled into the cap thereby creating a full-thickness duplication of the colonic wall; B: The over-the-scope clip is deployed; C: The tissue above the clip is resected with the integrated snare.

Figure 5 Endoscopic full thickness resection of a non-lifting recurrent adenoma in a patient with a polyposis syndrome. A: Endoscopic image showing a polypoid and centrally depressed non-lifting adenoma (2.5 cm) in the sigmoid (Narrow band imaging mode); B: View with the mounted full thickness resection device (FTRD, Ovesco Endoscopy, Tübingen, Germany); C: The lesion is pulled into the cap with a forceps; D: Resection site. The over-the-scope clip is securing gastric wall patency.