Overview

The gastointestinal (GI) tract is a part of your body that includes your food pipe (oesophagus), stomach, small bowel, liver, pancreas and large bowel (colon).

Any lesions (abnormal or damaged cells), polyps (small growths) and specific tumours in the GI tract need to be removed. This can be done by a procedure called an endoscopic full-thickness resection (EFTR) by using a full-thickness resection device (FTRD).

The term ‘resection’ means removal and ‘full-thickness’ refers to how much of the gastrointestinal wall is removed. 

This procedure is carried out using an endoscope, which is a flexible, tube-like instrument, and this procedure reduces the need to have surgery.

An EFTR can be done using conscious sedation, which is medicine that makes you relaxed and sometimes sleepy, but does not put you to sleep. Or it might be under general anaesthetic so that you are asleep throughout the procedure. We will discuss this with you in clinic before your procedure.

You can read more about having an anaesthetic or sedation.

Diagnosing a lesion

Patients will have a gastroscopy or colonoscopy to identify the lesion. This is usually followed by an endoscopic ultrasound or a CT scan for further details and to check the size of the tumour. 

Using EFTR to treat lesions

Stomach

We can use the EFTR procedure to remove a lesion in the lining of the stomach called a gastrointestinal stromal tumour (GIST). If these tumours are small they do not spread to other parts of the body. We can use the EFTR procedure if the tumour hasn’t spread and we are confident that we can remove all the GIST in one go.

Over time the tumours can grow and start to spread. If this happens we recommend that patients have regular CT scans or endoscopic ultrasounds to monitor them. 

Bowel

If a polyp has been found deep in the tissue of the bowel but has not spread outside of the bowel, we can use EFTR procedure to remove the polyp.

Benefits of having an EFTR

In the past patients with specific lesions located deep in the wall of the stomach or bowel needed to have surgery to remove them, as an endoscopic procedure could only remove the top layer of the lesion.

Having an EFTR means these specific lesions can be removed without the need for surgery. It also means that, during the procedure, we can use a microscope to examine all the wall layers to make sure all of the affected tissue is removed. 

Having an EFTR procedure will:

• remove the whole lesion, polyp or gastrointestinal stromal tumour (GIST)
• remove these lesions without the need for surgery
• remove the need for regular surveillance by CT scan or endoscopic ultrasound

Not everyone is suitable for an EFTR. You can be offered the procedure when:

• you have a lesion or polyp where a very small area is affected, typically less than 18mm
• the tissue is only showing early changes
• you have a GIST tumour, do not want to undergo surveillance or want the lesion removed

Risks

Your doctor will discuss these risks with you before asking you to sign a consent form.

• Bleeding. This is often minor, but can occasionally mean you need to go to hospital to control the bleeding. This happens in 1 out of every 200 people.
• Hole or tear (perforation) in the stomach or wall of the bowel. This affects about 2 in every 200 people. You would need to go to hospital if this happens. Sometimes, surgery is needed to repair it.
• Pain. It is common to feel chest pain or tummy (abdominal) pain for up to a week after the procedure. Try using your usual pain medicine first. If this does not help, you can ask for a codeine tablet from a pharmacy.
• Scar tissue. This is a risk if a large area of tissue is removed. Scar tissue can narrow the outlet of your stomach depending on where the lesion was removed from. This can cause sickness (vomiting). If this happens, contact your medical team. They will book you in for another gastroscopy so that the narrowing can be stretched. You might also have steroid treatment to help stop the scar tissue from forming.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead with your procedure or treatment, you will be asked to sign a consent form. This states that you agree to have the treatment and understand what it involves.

If you need more information before signing the consent form, for example if you have questions about recovering after an operation or about side effects of treatment, please speak to a member of staff caring for you.

Other treatment options

The only other treatment is surveillance, or watch and wait. 

You will be checked yearly or every 2 years. You will need an endoscopic ultrasound or a CT scan so we can examine the tumour. 

If the tumour has grown then we may be able to remove it during a colonoscopy by using endoscopic mucosal resection or endoscopic submuscosal dissection.

Or you may need surgery to cut out the GIST from the affected part of the stomach. This is a major operation where you may need to stay in hospital for some time.