Endoscopic Full Thickness Resection (EFTR)

Why have I been provided with this leaflet?

Previous tests have shown you have a “polyp” in your large bowel. Most polyps are removed by a small wire loop (snare).

Sometimes, if the polyp is growing deeply, it will require more specialist methods to remove it. 

Because of the location of your polyp, a procedure called EFTR (Endoscopic Full Thickness Resection) is required to remove it.

This leaflet explains to you more about what is involved.

What is a large bowel polyp?

A polyp is a small wart-like growth that sometimes forms on the lining of the bowel. Most polyps do not cause any symptoms, but in some cases, they can cause bleeding or a change in bowel habit.

Most polyps are harmless, but larger polyps have a small chance of containing cancer cells and if they are left to grow, some can become cancerous.

The majority of polyps can be removed using a camera test, such as an endoscopy (down your throat), colonoscopy or flexible sigmoidoscopy (in your bottom). By removing the polyps, your risk of developing bowel cancer is greatly reduced.

Polyps that are growing deeper into the wall of the bowel are more difficult to remove and are more likely to become cancerous if left untreated.

Why have I been referred for an EFTR procedure?

Your polyp may be growing deeper into the lining of the bowel.

This may be because of scarring from previous attempts at removal, or from an early cancer.

Having an EFTR (endoscopy) procedure has been deemed by an experienced Endoscopist as potentially the best option for your polyp to be successfully removed.

What is an Endoscopic Full Thickness Resection (EFTR)?

An Endoscopic Full Thickness Resection EFTR is a specialised procedure.

EFTR is most commonly used to remove benign polyps that have been assessed as requiring deeper resection than is usual for polypectomy.

Previously, difficult or awkward polyps were either partially treated by burning or scraping away.

Occasionally, they were treated by major surgery to remove the area affected. Because of EFTR, more of these polyps can be removed completely, without major surgery.

Occasionally, EFTR is used to remove small cancers. This is either because the cancer is in the early stages, or because a major operation is not possible.

We will usually administer a dose of antibiotic at the time of the procedure, to help prevent any infection. Please let us know if you have any allergies to medications.

1. The polyp is assessed and the edges are marked. The endoscope is then re-inserted with the resection device attached.
   
2. The polyp is grasped with special grasping forceps.
   
3. Forceps are used to pull the polyp into the cap of the device.
   
4. A special clip is closed onto the polyp tissue.
   
5. The polyp tissue above the clip is removed and retrieved inside the device.

The special clip securely holds the bowel tissue together (where the polyp has been removed).

The clip detaches from the healed bowel over time and is usually passed through the bowel without being noticed.

In most cases, you will be able to go home on the same day as the procedure. However, occasionally we may ask you to stay in hospital overnight for observation.

What are the benefits of removing the polyp?

Removal of the polyp will reduce your risk of developing bowel cancer and may treat any symptoms that are being caused by the polyp.

What are the risks of the EFTR?

These are explained in the colonoscopy information leaflet. However, because the polyp is growing into the bowel wall, the risk of perforation or bleeding during polyp removal is higher (although still not common).

The National Institute for Health and Care Excellence (NICE) has reviewed EFTR as a technique for removing polyps growing deep into the bowel wall.

NICE report that because this technique is relatively new, there is limited available evidence surrounding risks associated with the procedure. However, NICE do support using EFTR in certain situations.

A team of experts will have discussed your case to make sure we are recommending this technique appropriately.

The main risks are:

• Perforation – this means a tear in the bowel wall. For EFTR, this occurs in approximately 3 in every 100 patients. Occasionally, perforations heal with antibiotics and bowel rest and sometimes they can be treated with the endoscope. However, an emergency surgical operation is required in about half of cases.

As with any bowel operation, a stoma (bag on your abdomen) may be required, although this would usually be temporary.

• Bleeding – bleeding can happen in about 1 in 30 patients. Sometimes, bleeding occurs during the procedure, but it can also occur up to 14 days afterwards.

If bleeding does occur, it often stops on its own. However, very occasionally it requires a blood transfusion or further endoscopies.

Very rarely, emergency surgery may be needed to stop it. If you take any drugs to thin your blood, you will usually be asked to stop taking these temporarily prior to EFTR.

If you usually take Warfarin, we may arrange for you to have daily injections of heparin instead. This will help to reduce the risk of bleeding.

Most patients do not develop problems while they are not taking their blood thinning medication. However, there is an increased risk of developing blood clots or having a stroke during this time. This is something you may wish to discuss with the Endoscopist prior to your procedure.

• Incomplete removal – sometimes, the Endoscopist cannot remove the entire polyp for technical reasons (e.g. a polyp in a difficult position). If this happens, you may need a further attempt using the endoscope, or an operation that will be planned at a later date.

• Recurrence – Even when all the parts of the polyp seem to have been removed, the polyp can grow back. This is called recurrence.

Depending on the nature of the polyp, this can be happen in up to 1 in 5 of patients within a year after initial removal.

  This is why we arrange for routine endoscopy check-ups and usually this can be dealt with during these check-ups. Sometimes, the recurrence may mean a surgical operation is needed to remove the polyp completely.

You may wish to discuss the risks again with the Doctor or nurse who will seek your consent prior to the examination.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

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Telephone: 01642 383551

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Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Number: PIL1362
Date for Review: 09/02/2025