Full-Thickness Resection (EFTR) vs. Submucosal Dissection (ESD): Choosing the Right Approach for Complex Endoscopic Resection

 
Endoscopy has revolutionized the diagnosis and treatment of gastrointestinal (GI) conditions. Today, doctors can detect lesions just a few millimeters in size, perform biopsies, and remove abnormal tissue, all without traditional surgery. But when lesions are deep in the GI tract wall, more advanced techniques are needed. Two cutting-edge solutions, Endoscopic Full-Thickness Resection (EFTR) using the Full-Thickness Resection Device (FTRD) and Endoscopic Submucosal Dissection (ESD), are transforming care for patients worldwide.
 
At Bumrungrad International Hospital’s Digestive Disease Center, patients have access to both procedures. Bumrungrad is the first hospital in Thailand, and among the few in the region, where EFTR with FTRD is regularly practiced.

 

What Is EFTR Using the Full-Thickness Resection Device (FTRD)?

EFTR with FTRD is an advanced endoscopic technique designed to remove deep-seated growths or lesions that cannot be safely removed with conventional methods.

• A specially designed device attached to the endoscope allows the gastroenterologist to remove the full thickness of the GI wall in a controlled way.
• This technique often eliminates the need for surgery by removing early cancerous and precancerous lesions in one piece, enabling pathologists to determine if cancer cells have spread to lymphatic or nerve tissues.

Conditions treated with EFTR include:

• Deep tumors or lesions in the digestive tract wall

Common side effects may include:

• Mild sore throat for upper GI use
• Nausea or vomiting
• Gas, bloating, or cramping
• Mild abdominal or rectal discomfort

 

What Is Endoscopic Submucosal Dissection (ESD)?

Endoscopic Submucosal Dissection (ESD) is a minimally invasive technique for removing early-stage cancers, flat polyps, and precancerous lesions in the esophagus, stomach, colon, or rectum.

• The doctor uses a flexible endoscope to carefully dissect under the lesion, separating it from deeper tissues.
• ESD avoids external incisions, allowing for precise removal of lesions with minimal trauma and faster recovery.

Conditions treated with ESD include:

• Early-stage cancers of the esophagus, stomach, colon, and rectum
• Large or flat polyps
• Certain subepithelial lesions

Common risks include:

• Minor bleeding, usually controlled during the procedure
• Rare risk of perforation of the digestive tract wall
• Minimal risk of infection

 
 

 
 

Why Choose Bumrungrad for EFTR or ESD?

• Pioneering expertise: First hospital in Thailand to perform EFTR with FTRD.
• World-class endoscopy unit: At the GI-Broncho Endoscopy Unit, certified by the EURP (Endoscopy Unit Recognition Program) and powered by the ASGE (American Society for Gastrointestinal Endoscopy), Bumrungrad proudly holds the distinction of being the first unit in Thailand and Southeast Asia to receive this accreditation.
• Highly trained specialists: Our endoscopists are trained at leading U.S. specialty hospitals and utilize state-of-the-art endoscopic technology.
• Advanced technology: State-of-the-art endoscopic equipment and a multidisciplinary tumor board support each case.
• Fewer surgeries, faster recovery: Many patients can avoid traditional surgery entirely.

 

Bottom line:

Both FTRD and ESD offer groundbreaking, minimally invasive alternatives to surgery for complex GI lesions. Your doctor will recommend the best approach based on the location, depth, and type of lesion, and with Bumrungrad’s expertise, you have access to both world-class options in one center.
 
 

Frequently Asked Questions About FTRD and ESD

1. What is the difference between FTRD and ESD?

• FTRD (Full-Thickness Resection Device) removes the entire wall layer of the GI tract, making it ideal for deep-seated tumors.
• ESD (Endoscopic Submucosal Dissection) removes lesions from just under the mucosal layer, best for early-stage cancers and large or flat polyps.

2. When would a doctor recommend FTRD instead of ESD?

• FTRD is usually chosen when lesions are deeply embedded in the GI wall, or when a standard resection might not remove all affected tissue.

3. What are the main benefits of ESD?

• ESD allows for complete removal of early-stage cancers and polyps without external incisions, leading to less pain, faster healing, and minimal scarring.

4. Is recovery faster with FTRD or ESD?

• Both are minimally invasive with shorter recovery compared to surgery.

5. Why choose Bumrungrad International Hospital for these procedures?

• Bumrungrad’s Digestive Disease Center, home to the GI-Broncho Endoscopy Unit certified by the EURP (Endoscopy Unit Recognition Program) and powered by the ASGE (American Society for Gastrointestinal Endoscopy), is proudly the first unit in Thailand and Southeast Asia to earn this prestigious accreditation. Our endoscopists, trained at leading U.S. specialty hospitals, bring world-class expertise in advanced procedures like EFTR using FTRD and ESD, helping patients avoid invasive surgery and begin recovery almost immediately.

Reviewed by 
Asst.Prof.Dr. Veeravich Jaruvongvanich