Endoscopic Full-Thickness Resection for Gastrointestinal Subepithelial and Epithelial Neoplasia: Current Status, Indications, and Technical and Oncological Challenges-A Multispecialty Perspective.

Endoscopic full-thickness resection (EFTR) has emerged as a minimally invasive treatment for small gastrointestinal subepithelial neoplasms (SETs). In particular, the development of novel closure methods such as clip-line and various endoscopic suturing techniques has enabled the secure closure of any resultant defects. During the Advanced Therapeutic Endoscopy session at the Endoscopic Forum Japan 2025, we summarized the current status of EFTR for SETs and discussed future clinical applications for epithelial neoplasms from oncological and technical perspectives. Although predominantly documented in gastric subepithelial neoplasms, EFTR is also used to treat select esophageal, duodenal, and colorectal SETs. While extensively evaluated for gastric gastrointestinal stromal tumors (GISTs), relatively low R0 resection rates have limited its broader clinical adoption; however, the novel no-touch EFTR technique could overcome this challenge and facilitate the adoption of this procedure for small gastric GISTs. Applying EFTR to epithelial tumors requires strict assessment of oncological clearance, given the risks of lymph node metastasis and peritoneal seeding following full-thickness breaches. At the end of the session, we voted on the appropriateness of EFTR for epithelial neoplasms across different organs, balancing oncological risks against technical feasibility. All nine participants (100%) supported EFTR for rectal lesions, and eight (89%) supported its use for gastric lesions. Future investigations and technical innovations are required to expand the clinical indications for EFTR in epithelial neoplasms.