Endoscopic full-thickness resection (EFTR) by using non-exposed full-thickness resection device (FTRD) is a safe procedure often adopted for non-lifting colorectal lesions.  As showed by recent literature, one of the technical challenges may be reaching the lesion after mounting the FTRD device on the colonoscope, particularly in case of difficult colonoscopy due to loop formation or laxity.  This issue may lead to procedural failure as well as damage and exposure to complications.

We combined the FTRD with the use of Endorail System, an accessory for colonoscopy that uses a magnetic balloon to solve colon loops and improve the manoeuvrability of the endoscope. It consists of a balloon catheter introduced through the endoscope’s channel, filled with a ferromagnetic fluid, and then magnetically anchored to a handpiece placed on the patient's abdomen. This allows the endoscopist to pull the colonoscope and straighten loops, making the procedure faster and complete. We entered an Endorail-assisted EFTR for a single case of appendiceal adenoma. 

We evaluated a 74-year-old woman with a 20 mm sessile adenoma of the appendiceal orifice and history of incomplete colonoscopies due to laxity, loop formation and the concomitant need for prolonged sedation.

We performed a complete traditional colonoscopy. After reaching the ceacum and marking the lesion, we released the Endorail balloon in the ascending colon to stabilize the position and it was left in situ as a guide. Through the transcutaneous magnetic anchoring system, the balloon remained stationary in position and was therefore used as a guide alongside the endoscope for performing colonoscopy with FTRD. Reaching the caecum by following this guide was extremely easy and took 4 minutes less time, without any loops forming or difficulties in proceeding in the lumen. After reaching and removing the magnetic balloon, the full-thickness resection procedure was successfully completed, with no immediate or late adverse events. In particular, there was no damage to the remaining colon and no acute appendicitis occurred in the following days. Histological examination confirmed curative and ful-thickness resection of tubular adenoma with low-and high-grade dysplasia.

Our experience shows how combining two devices can help overcome difficulties challenges, reduce potential adverse events and lead to safer technical success in less time.