Endoscopic Full-Thickness Resection for Colorectal Neoplasm: Current Status and Future Directions

Purpose of Review Endoscopic submucosal dissection (ESD) is recognized as a minimally invasive treatment for colorectal cancer. However, colorectal ESD has not been internationally accepted as a first-line therapeutic option due to technical difficulties and high complication rates. Non-lifting tumors present a further limitation of ESD. Colorectal endoscopic full-thickness resection (eFTR) with over-the-scope clips (OTSCs) shows great potential in patients for whom ESD is not possible and also for those who might have ESD-related complications. The present manuscript aims to discuss the complementary role of eFTR using OTSCs and the future development of eFTR with a novel suturing device. Recent Findings Colorectal eFTR is feasible and has acceptable en bloc and R0 resection rates and procedure-related adverse events. This technique is primarily used for non-lifting and recurrent adenomas, especially in lesions <= 2 cm. This approach offers the potential to decrease the postoperative morbidity and mortality associated with segmental colectomy while enhancing the diagnostic yield compared to that of current endoscopic techniques. Summary eFTR using OTSCs is a safe and effective procedure for treating colorectal non-lifting and recurrent adenoma. The indications may be expanded to include subepithelial tumors, carcinoid tumors, and neuromuscular GI disorders. eFTR using OTSCs is not recommended for large lesions (> 30 mm), but innovative methods and new devices for eFTR and suturing will overcome the limitations by allowing minimally invasive surgery for colorectal cancer in the near future.