FTRD (Full Thickness Resection Device)

Not every colorectal lesion is straightforward to remove with standard endoscopic techniques (see the EMR & ESD page). Some polyps don't lift properly when fluid is injected beneath them — called 'non-lifting' polyps, often because of scarring from a previous attempted removal or deeper attachment to the bowel wall — and some lesions originate from a deeper layer than EMR or ESD are designed to reach. FTRD (Full Thickness Resection Device) was developed specifically for these more difficult cases: it removes the full thickness of the affected bowel wall in one step, using a single device that also seals the resulting defect at the same time.

Yes, and for the specific difficult lesions it's designed to treat, it performs very well. Technical success — successfully reaching and removing the lesion — is achieved in roughly 9 out of 10 procedures, with complete removal confirmed by pathology in the large majority of cases. For certain non-lifting lesions specifically, direct comparison studies have found FTRD actually outperforms ESD, with higher technical success, higher complete removal rates, and fewer complications. Complications overall occur in roughly 1 in 10 procedures, most commonly minor bleeding; more serious complications like perforation are less common. One specific, worth-knowing risk: for lesions located near the appendix, there's a meaningfully higher chance of appendicitis afterward, which is factored into planning for those specific cases. In a minority of cases, particularly where cancer is found on final pathology, further treatment including surgery is still needed — this isn't a failure of the procedure, but part of properly matching treatment to what's actually found. The section further down this page, ‘The evidence in more detail,’ has the specific study data.

• Non-lifting polyps — lesions that don't lift normally with submucosal injection, often due to prior removal attempts or scarring
• Lesions originating from a deeper layer of the bowel wall than standard EMR or ESD can safely address
• Small, early-stage (T1) colorectal cancers in select cases
• Small neuroendocrine tumors
• Residual or recurrent adenomas after a previous incomplete removal

• Before: colonoscopy to characterize the lesion and confirm FTRD is the appropriate approach, given its specific indications
• During: performed under sedation; the device draws the lesion and surrounding bowel wall into a cap, places a clip to close the area, then removes the tissue — combining resection and closure in one step
• After: most patients recover quickly, often going home the same day or after a short observation period
• Follow-up: the removed tissue is sent for pathology; surveillance endoscopy is scheduled based on those findings

This section is for anyone who wants the specific research behind the summary above — it's not necessary reading to understand the basics of this procedure, but it's here for transparency.

A meta-analysis of 9 studies covering 551 patients found technical success of 89.25% and complete (R0) resection of 82.4%, with a total complication rate of 10.2% (minor bleeding 3.2%, major bleeding 0.97%, perforation 1.2%). A larger systematic review of 26 studies and 1,538 procedures found the target lesion was successfully reached in 96.1% of cases, with technical success of 90.0% and complete resection of 77.8%. A direct comparison study of lesions up to 30mm found FTRD achieved significantly higher technical success than ESD (92% versus 74%) and higher complete resection (85% versus 62%), with fewer complications. For lesions located near the appendix specifically, one analysis found a 19.7% rate of subsequent appendicitis, an important consideration for that specific lesion location. In a notable minority of cases (reported as high as 15.3% in one large series), further oncologic surgery was still needed after FTRD, generally when final pathology showed more advanced disease than initially expected.

FTRD is the answer for lesions a standard snare cannot take safely — scarred or recurrent colon polyps, lesions sitting at the appendiceal orifice or within a diverticulum, and small subepithelial tumours. Our gastroenterologists use it to keep patients out of bowel resection where the lesion is otherwise resectable. To have a lesion previously called unresectable reassessed, book a consultation.