Git j club eftr geenac.

1. Kurdistan Board GEH J Club:
Supervised by:
Dr. Mohamed Alshekhani
Professor in Medicine
MBChB-CABM-FRCP-EBGH 2016
1

2. Introduction:
• Endoscopic removal of GIT tumors: EMR,ESD,ESE,EMD,EFTR.
• Endoscopists have become more & more aggressive in endoscopic
resection from EMR to ESD for en bloc resection of superficial
mucosal & submucosal GI tumors.
• Endoscopic submucosal excavation (ESE) or endoscopic muscularis
dissection (EMD) : New techniques for muscularis propria
subepithelial tumors (SETs) without any extraluminal growth
component ,cannot guarantee a negative resection margin of
muscularis-based tumors such as GISTs
• EFTR: removal of SETs with the use of a ligation device (EFTR-L),
followed by endoscopic complete defect closure.

3. EFTR: Indications
• Should only be carried out by very skilled endoscopists who have
mastered ESD.
• EFTR is most frequently used in SETs originating from the MP in the
upper GI tract & recently lower GI tract.
• Used to resect large laterally spreading tumors & submucosal
tumors arising from the submucosa or MP.
• Advantages:
• Allows complete resection of tumors.
• Reduces the risk of residual tumor.
• Improves accuracy of pathologic diagnosis/staging.

5. Preoperative assessment:
• Should have a preparation similar to general GI surgery.
• 1. Medical staff &endoscopic accessories:
• EFTR requires at least 2 trained nurses or technicians &an
experienced endoscopist that must have mastered electrosurgical,
hemostatic &closure techniques&devices to achieve efficient/
complete resection while minimizing & managing adverse events.
• The instruments are essentially the same as those used for ESD.
• A dual-channel endoscope & grasping forceps can be used to
prevent the tumor from falling into the abdominal cavity.
• For closure of the GI wall defect, in most clinical settings in which
advanced suturing devices are not commercially available, purse-
string closure via metallic clips& Endoloops is the most commonly
used technique.

6. The procedure: Video

17. Summary:
• EFTR a surgical procedure with the lowest degree of invasiveness
allowing removal SETs easily& without incisions from the mouth or
anus using a flexible endoscope.
• Recent developments have brought EFTR into clinical use for
selected indications.
• The merits of extremely minimally invasive surgery are reducing
the burden (financial, physical, mental) on patients &medical costs.
• Several challenges:
• (1) The promotion of the emerging suturing& EFTR devices into
daily endoscopic practice.
• (2) The multidisciplinary training of endoscopists to gain knowledge
of gastroenterology&general surgery.
• (3) The development of new devices that improve aspects of EFTR
that remain inferior to surgical technologies such as novel robust
hemostatic devices&staplers.