Endoscopic Full Thickness Resection Device (FTRD®) for the Management of Gastrointestinal Lesions: Current Evidence and Future Perspectives

Abstract

Endoscopic full-thickness resection (EFTR) has emerged as a transformative technique for managing gastrointestinal (GI) lesions, previously deemed unsuitable for endoscopic removal. Unlike conventional endoscopic resection methods, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), EFTR enables en bloc excision of both intraluminal and subepithelial lesions by resecting all layers of the GI wall, followed by defect closure to prevent complications. The introduction of the full-thickness resection device (FTRD^®) has significantly enhanced the feasibility and safety of EFTR, particularly in the colon and upper GI tract, with increasing adoption worldwide. This review provides a comprehensive analysis of FTRD^®, focusing on its clinical applications, procedural methodology, and comparative efficacy against other endoscopic resection techniques. The indications and contraindications for EFTR are explored, highlighting its utility in treating non-lifting adenomas, subepithelial tumours, and T1 carcinomas without lymph node involvement. This review synthesizes current clinical data and FTRD^® advantages. Despite its strengths, EFTR via FTRD^® incorporates challenges such as limitations in lesion size, procedural complexity, and potential adverse events. Strategies for overcoming these challenges, including hybrid techniques and modifications in procedural approach, are examined. The review also emphasizes the need for further research to optimize surveillance strategies and determine the long-term clinical impact of EFTR in GI lesion management. By integrating recent evidence, this paper provides valuable insights into the evolving role of EFTR in therapeutic endoscopy.

Keywords: EFTR; FTRD®; endoscopic resection; full thickness resection device; gastrointestinal lesions.

Figure 1

(A) Visualisation of a recurrent adenoma in sigmoid colon; (B) marking of the lesion using argon-plasma coagulation; (C–E) grasping and mobilizing the lesion within the device using suction and forceps—ensuring the lesion is completely in the cap and applying the clip, using the dedicated wheel attached to the scope; (F) resecting the tissue above the clip arms and retrieving a specimen (all photos are courtesy of the authors).