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Endoscopic full thickness resection (EFTR) is a non-surgical option for colon cancer
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Endoscopic full thickness resection (EFTR) is a non-surgical option for colon cancer

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Dr. Davinderbir Pannu

Dr. Davinderbir Pannu, a McLeod gastroenterologist, performs an advanced endoscopy procedure in one of the new McLeod Regional Medical Center Endoscopy Services procedure rooms.

Even with screening options like colonoscopies being performed for many people, colon cancer remains the second leading cause of death from cancer in both men and women in South Carolina.

For those whose diagnosis of cancer is discovered early, or those who have high-risk changes that will progress to cancer, there is a new procedure available that may provide a cure without surgery or need for further treatment: endoscopic full thickness resection, or EFTR.

Endoscopic full thickness resection is an outpatient procedure to remove growths deep in the wall of the gastrointestinal (GI) tract. Under mild sedation, gastroenterologists (physicians trained to treat the digestive system and GI tract) use a flexible, tube-like imaging instrument called an endoscope to look inside the body.

When performing EFTR, gastroenterologists use specially designed endoscopes that include an external device designed to remove a suspicious lesion, such as a high-risk polyp or a tumor, which could be a benign or cancerous growth. This procedure makes it possible for many patients to avoid a more invasive surgical procedure. The result may be a shorter treatment time and faster recovery.

EFTR is most often recommended following a regular screening colonoscopy when a suspicious polyp or tumor is found. After discussion with their primary care physician or gastroenterologist, patients are scheduled for the procedure with an interventional advanced endoscopy physician. As with many GI procedures, the patients will need to take laxatives to cleanse the bowel the night before their appointment.

Once arriving at the hospital, patients will be given sedatives and anesthesia to ease the process. The physicians then insert a high-definition endoscope through the mouth (for an upper GI tract procedure) or the anus (for a lower GI tract procedure) and observe the images on a screen.

The actual removal of the target polyp/tumor occurs in the following steps performed by the team:

Locate and mark the edges of the tumor with a tool inserted through the endoscope.

Feed tiny forceps (tongs) through the endoscope to grasp the tumor.

Use the forceps to pull the tumor up into the tube of the endoscope until the edges of the tumor are visible in the tube.

Use a special clip on the endoscope to cut the tissue from the body. The clip remains safely in the body, acting as a suture.

Carefully remove the tissue through the endoscope.

Once the patient wakes up from the anesthesia, the physician will discuss the results and next steps for follow-up. In most instances, patients go home later the same day. The tissue will then be sent to a laboratory to confirm that the tumor was completely removed.

If the cancer is limited to the tumor and shows no spread to other areas, no other treatment may be needed and the cancer is cured without surgery, radiation or chemotherapy. Patients will need to have regular follow-up colonoscopies as determined by their physician to detect any recurrence or future developments.

This treatment option is an exciting and important development in the fight against colon cancer, but it is only effective when cancer is detected early. The key to early detection remains having a colonoscopy.

The American Cancer Society recommends that the first colonoscopy should be performed at age 50 (45 in African-Americans) if you are healthy and have no family history of colon cancer. Those with a family history or other contributing factors may need to be screened earlier. Talk to your primary care physician or gastroenterologist about the best time to schedule your colonoscopy.

Dr. Davinderbir Pannu, an advanced endoscopy gastroenterologist, performs the EFTR procedure and other advanced endoscopic procedures at McLeod Regional Medical Center in Florence.For more information about colon cancer, colonoscopy and other treatment options, visit mcleodhealth.org.

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