Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video)



Clip-assisted endoscopic full-thickness resection (EFTR) with an over-the-scope device has been recently described to be feasible and effective for the resection of non-lifting adenomas in the lower gastrointestinal tract. However, tumor size is the major limitation of that technique. We describe a hybrid technique using endoscopic mucosal resection (EMR) in ten patients with large non-lifting colorectal adenomas to reduce tumor size and facilitate clip-assisted EFTR.


Data of ten consecutive patients (median age 72.5 years, SD 8.86) who underwent combined EMR and EFTR in the colon were analyzed retrospectively. The main outcome measures were technical success, histological confirmation of full-thickness resection, and adverse events.


All lesions (median size 35.5 mm, SD 5.99) could be resected successfully. No immediate or delayed adverse events were observed. Histology confirmed full-thickness resection in all cases. Three-month follow-up showed no residual or recurrent adenomas.


Hybrid EMR–EFTR in the colon seems to be an effective approach for large non-lifting lesions with positive lateral lifting signs. Prospective studies are needed to further evaluate efficacy, safety, rate of recurrence, and long-term outcome of this technique.

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Fig. 1

(Reprinted with permission from Ovesco Endoscopy, Tübingen, Germany)

Fig. 2

(Reprinted with permission from Ovesco Endoscopy, Tübingen, Germany)

Fig. 3



Conformité Européenne




Endoscopic full-thickness resection


Endoscopic mucosal resection


Endoscopic submucosal dissection




Full-thickness resection device




Lateral spreading type-granular








Narrow band imaging


NBI (narrow band imaging) international colorectal endoscopic


Over-the-scope clip


Complete resection




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We thank Ovesco Endoscopy for the technical support. We also thank Professor Dr. Hermann and Dr. Mühleisen from the Department of Pathology at our institution for providing the histologic images.

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Correspondence to Benjamin Meier.

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Prof. Caca and Dr. Schmidt have received lecture fees for FTRD training courses from Ovesco Endoscopy. Dr. Meier has no conflicts of interest or financial ties to disclose.

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Meier, B., Caca, K. & Schmidt, A. Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video). Surg Endosc 31, 4268–4274 (2017).

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  • Full-thickness resection
  • FTRD
  • Large non-lifting adenomas