Endoscopic Submucosal Dissection

Endoscopic full thickness resection (EFTR) Endoscopic and Clip assisted with over the scope clip:

It is an effective and safe technique to treat and remove growths in the gastrointestinal passage. It is an outpatient procedure so that the doctor can treat the growth or tumours without surgery, and no post-operative scar is left behind on the abdomen. Due to this, you can avoid more invasive surgery, and the treatment and recovery time is reduced.

What can it do?

It is used in the case of bowel disease to remove growths from the large bowel. Following are the various types of growths it can address.

  • Polyps growing from the inside of a diverticulum (bowel disease where there is a bowel wall’s outpouching) or the appendix.
  • Small tumours developing from the bowel wall’s deeper layers.
  • Scarred polyps stuck down to deeper layers of the walls of the bowel.
  • Very early large bowel cancers, not spread further than the bowel lining.
  • EFTR is more effective than other procedures in removing tumours embedded in the gastrointestinal walls. Doctors can also use it for treating gastrointestinal bleeding, post-surgical Perforation, polypectomy and chronic fistula.
The Pre-assessment of EFTR

Information about your medical history, allergies and any medications you are taking, especially for diabetes, blood thinning or iron tablets, will be collected. Please let them know if you have a pacemaker (“PPM”) or defibrillator (“ICD”) for your heart.

The Procedure

The EFTR procedure will be conducted by an expert who is trained especially for it. The procedure can extend to about two hours. For most of the procedure, an anaesthetist will keep you deeply sedated unless it was decided in the clinic that you will go with no sedation or just lighter sedation. If it becomes essential, antibiotics might be given to you during the procedure into the vein.

When you are sedated, to check the area that needs to be removed, a tiny camera called an endoscope is inserted into your back passage. If everything is found conducive, the first camera will be removed, and a second one with a full thickness resection device mounted on it is inserted to remove the growth.

The edges of the tumour are marked with the tool inserted through the endoscope. Tiny forceps are inserted through the endoscope to grasp the tumour. With the help of the forceps, the tumour is pulled up into the tube of the endoscope. A special clip on the endoscope is used to cut the tissue from the body. The clip remains safely in the body, acting as a suture.

The removed growth is sent for microscopic examination to a laboratory. The results generally come in three to four weeks.

Is it possible to return home right after the procedure is complete?

Under some circumstances, you can go home the same day. Yet, it is better to carry an overnight bag just in case you need to be kept under observation for a day or two.

If you are allowed to return home after the procedure, it will be important to have a responsible adult taking you home (do not take public transport or drive yourself or) and caring for you, at least overnight.

Could any problem arise with EFTR?

There is a possibility of a failed procedure, but such cases are rare the world over. Difficulty in completing the growth can also be possible, but your doctor will discuss possible alternatives with you and give the right advice. Postoperative infections, excess bleeding needing a blood transfusion, a hole in the bowel wall or some organ positioned near the large bowel getting damaged by the device and needing to be repaired can also happen.

Such problems are rare as the devices and the techniques today are vastly improved, and very efficient and trained staff are treating and monitoring you throughout the process.

What else, if not EFTR?

If you do not want to go for EFTR, you could opt for:

  • Surgery
  • No treatment at all

The decision whether you should go for surgery or not do anything about the growth is dependent on the following factors:

  • Type of growth
  • Your general health
  • Type of operation that needs to be performed

You can decide which option to choose in consultation with experts at the hospital who will guide you and provide answers to all your queries and concerns.

Post-surgery, what are the alarming signs that need immediate medical attention

  • Severe abdominal pain
  • Vomiting
  • Passing of blood clots or a large amount of blood from your back passage

OTS Clip assisted EFTR is a convenient option. It is not only effective and safe but also less draining on your finances, health and energy. The treatment and recovery period is much less than in surgery. The chances of a failed procedure are negligible, and you can lead a normal life after recovery.