Pathology perspective on endoscopic full thickness resection

Recent advances in minimally invasive endoscopic approaches have introduced new resection techniques including the Endoscopic Full Thickness Resection (EFTR) for therapeutic and diagnostic applications. EFTR offers minimally invasive surgery for mucosal or subepithelial lesions that cannot be resected with standard Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection techniques, due to anatomical location or presence of fibrosis (nonlifting epithelial lesions) allowing a safe and effective method to resect the entire gastrointestinal (GI) wall. EFTR is particularly useful for resecting small (<2 cm) subepithelial lesions that arise within the muscular wall that previously required a surgical approach. In addition to therapeutic resections, EFTR biopsies can be diagnostically useful for evaluating a variety of gastrointestinal neuromuscular diseases as well as diagnosing other inflammatory and neoplastic conditions that involve deeper layers of the gut wall. With refinement in resection techniques and increased experience with EFTR, indications for minimally invasive surgery will increase and a standardized pathologic assessment of these specimens will be incorporated into working practice guidelines.