Successful treatment of life-threatening bleeding from a duodenal posterior bulb peptic ulcer by an over-the-scope-clip

Successful closure of chronic recurrent Enterocutaneous fistula with a concurrent over-the-scope closure and a stent placement

Gastrointestinal ulcers and perforations can occur as a complication of nonsteroidal anti-inflammatory drugs (NSAID). Emerging endoscopic technologies can be utilized to successfully intervene perforations that fail surgical intervention. We report a case of perforated duodenal ulcer that failed surgical intervention and, however, was successfully closed with over-the-scope clip (OTSC) closure with concomitant placement of fully covered stent.

Current status and future perspectives of endoscopic full-thickness resection

Flexible endoscopy has developed from a diagnostic tool for tissue biopsy sampling to a treatment tool for endoscopic resection of neoplasms in the digestive tract. In the near future, one of the advanced endoscopic techniques, endoscopic full-thickness resection (EFTR), is expected to be a feasible endoscopic procedure. In the present review, systematic review of conventional exposed EFTR was carried out. Search queries were (endoscopic full-thickness resection or EFTR) (over-the-scope clip or OTSC) (Overstitch System) from 2015 to 2017. Four retrospective, single-center studies with regard to conventional EFTR were identified. With regard to indication for conventional exposed EFTR, gastrointestinal stromal tumor was a good indication for EFTR. Mean tumor size of all four studies was 20.71 mm. In two studies, endoclips were used to close the resected opening without any complications, but the other two studies reported complications such as delayed perforation even using OTSC. Procedure times were reported from a minimum of 40 min to a maximum of 105 min. We also refer to introduction of a newly developed procedure of EFTR (non-exposed EFTR), and development of a new suturing device in Japan.

Current Status of Exposed Endoscopic Full-Thickness Resection and Further Development of Non-Exposed Endoscopic Full-Thickness Resection

Endoscopic full-thickness resection (EFTR) is a procedure that makes it possible to access the lesions that are on the wall of the digestive tract via the shortest distance through the mouth. Because of the ultra-minimal invasive nature of the treatment, pure EFTR is a highly promising surgical procedure that allows the radical excision of full-thickness layers of digestive tract tumors using only a flexible endoscope. There are 2 types of EFTR methods: exposed and non-exposed. Considering the risks of contracting infection and intraperitoneal dissemination of tumor cells, non-exposed EFTR is an ideal method. However, a number of issues remain unresolved, including the method for performing a full-thickness suture under endoscopic view and the challenge of securing the operating field in the case of gastrointestinal tract collapse. Moreover, advances in the development of equipment such as full-thickness suturing devices would be helpful to make this therapeutic procedure the most minimally invasive endoscopic surgery ever.