FULL THICKNESS RESECTION DEVICE (FTRD) DISPLACEMENT AS A CAUSE OF DELAYED PERFORATION: WHEN COLONOSCOPY IS SAFE?

Aims Endoscopic full thickness resection (EFTR) yields excellent resection rates for benign recurrent adenomas with non-lifting sign, submucosal lesions which are not amenable of standard endoscopic resection and advanced histopathological lesions in patients unfit for surgery. The FTRD is the only commercially available over-the-scope device designed for EFTR with a one-step clip-and-cut technique. The major complications are bleeding and perforation that appears to be mostly related to an incomplete closure of the FTRD.

Methods We report a case of a 82-year old man, unfit for surgery, which was diagnosed with two colonic lesions: the first (20 mm) was located in the descending colon and it was highly suspicious for advanced adenoma with non-lifting sign and centrally depressed area. The second was a sessile adenoma (80 mm) located in the transverse colon. We decided to approach with EFTR the lesion of the descending colon and then, in a second session, to perform EMR in the transverse colon.

Results The EFTR was safe without complications and the patient was discharged the day after. One week later, a second colonoscopy was performed to treat the lesion in the transverse colon. During the procedure abdominal distension was noted and during withdrawal maneuver the FTRD appeared to be still in position. A CT-scan showed bubbles of extraluminal air in the abdomen closed to the FTRD. The day after we revised the FTRD site and two mucosal leaks were found and successfully treated with metallic clips deployment.

Conclusions Our case is the first description of a FTRD dislodgment occurred one week after the EFTR, maybe due to the colonscope passage over the device. This case raises the question of when colonoscopy is a safe procedure in a patient who has undergone an EFTR to avoid device displacement and subsequent delayed perforation.