• Adenoma relapse
• Colorectal cancer
• Full thickness resection
• No lift lesion
• Scar of previous endoscopic resection

Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multipurpose flexible endoscope is therefore considered a socially urgent issue.

• Micro-Electrical-Mechanical Systems
• Minimally invasive surgical procedures
• Suturing
• Traction

Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.

• Endoscopic full-thickness resection
• Over-the-scope-clip
• Colorectal adenoma
• Colorectal carcinoma
• Endoscopic gastrointestinal surgery

• Endoscopes, Gastrointestinal
• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/instrumentation
• Endoscopy, Gastrointestinal/methods
• Equipment Design
• Gastrointestinal Neoplasms/pathology
• Gastrointestinal Neoplasms/surgery
• Humans
• Predictive Value of Tests
• Treatment Outcome

AIM: To evaluate the efficacy, safety and feasibility of endoscopic full-thickness resection (EFR) for the treatment of gastric submucosal tumors (SMTs) arising from the muscularis propria.

METHODS: A total of 35 gastric SMTs arising from the muscularis propria layer were resected by EFR between January 2010 and September 2013. EFR consists of five major steps: injecting normal saline into the submucosa; pre-cutting the mucosal and submucosal layers around the lesion; making a circumferential incision as deep as the muscularis propria around the lesion using endoscopic submucosal dissection and an incision into the serosal layer around the lesion with a Hook knife; a full-thickness resection of the tumor, including the serosal layer with a Hook or IT knife; and closing the gastric wall with metallic clips.

RESULTS: Of the 35 gastric SMTs, 14 were located at the fundus, and 21 at the corpus. EFR removed all of the SMTs successfully, and the complete resection rate was 100%. The mean operation time was 90 min (60-155 min), the mean hospitalization time was 6.0 d (4-10 d), and the mean tumor size was 2.8 cm (2.0-4.5 cm). Pathological examination confirmed the presence of gastric stromal tumors in 25 patients, leiomyomas in 7 and gastric autonomous nerve tumors in 2. No gastric bleeding, peritonitis or abdominal abscess occurred after EFR. Postoperative contrast roentgenography on the third day detected no contrast extravasation into the abdominal cavity. The mean follow-up period was 6 mo, with no lesion residue or recurrence noted.

CONCLUSION: EFR is efficacious, safe and minimally invasive for patients with gastric SMTs arising from the muscularis propria layer. This technique is able to resect deep gastric lesions while providing precise pathological information about the lesion. With the development of EFR, the indications of endoscopic resection might be extended.

• Submucosal tumor
• Stomach
• Endoscopic full-thickness resection
• Muscularis propria layer
• Excision

• Adult
• Aged
• Feasibility Studies
• Female
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastroscopy/adverse effects
• Gastroscopy/methods
• Humans
• Length of Stay
• Male
• Middle Aged
• Operative Time
• Pneumoperitoneum/etiology
• Pneumoperitoneum/therapy
• Punctures
• Retrospective Studies
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Time Factors
• Treatment Outcome
• Young Adult

• Endoscopy
• Full-thickness resection
• Gastric stromal tumors
• Muscularis propria
• Treatment

• Adult
• Aged
• Biomarkers, Tumor/analysis
• Chi-Square Distribution
• China
• Female
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastrointestinal Stromal Tumors/chemistry
• Gastrointestinal Stromal Tumors/pathology
• Gastrointestinal Stromal Tumors/surgery
• Gastroscopy/adverse effects
• Humans
• Immunohistochemistry
• Laparoscopy/adverse effects
• Leiomyoma/chemistry
• Leiomyoma/pathology
• Leiomyoma/surgery
• Length of Stay
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Neurilemmoma/chemistry
• Neurilemmoma/pathology
• Neurilemmoma/surgery
• Operative Time
• Postoperative Complications/therapy
• Retrospective Studies
• Stomach Neoplasms/chemistry
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Time Factors
• Treatment Outcome