Third-space endoscopy

EFTR (Endoscopic Full-Thickness Resection) in Delhi

Endoscopic removal of tumours arising from the muscle layer of the gut wall

Dr Surakshith T K performs EFTR in Delhi for selected subepithelial tumours that arise from the deeper muscle layer — small gastric GISTs among them — where anything less than full-thickness removal would leave tumour behind. EFTR is part of his third-space practice, alongside POEM and ESD.

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250+third-space procedures Full thicknessthe whole wall, then closed endoscopically No incisionperformed through the endoscope
Dr Surakshith T K, third-space endoscopy specialist in Delhi, performing endoscopic full-thickness resection
Dr Surakshith T KThird-space endoscopy · EFTR & ESD · Delhi
MBBS · MD (Medicine) · DNB (Gastroenterology) DNB — Sir Ganga Ram Hospital, New Delhi ESD & IEE training — Jichi Medical University · Osaka International Cancer Institute, Japan 15+ years’ experience Member — ACG · WEO · INASL · SGEI

What is EFTR (endoscopic full-thickness resection)?

EFTR is an advanced endoscopic technique in which a lesion is removed through the entire thickness of the gastrointestinal wall, and the resulting defect is then closed from inside with clips, a suturing device or an over-the-scope clip. It is used for tumours that grow from the muscle layer rather than the lining — lesions that a snare or an ESD knife cannot remove completely. It is performed entirely through the endoscope, with no external incision.

Indications

What EFTR is used for

EFTR is considered for lesions that arise below the lining, where the depth of origin decides the technique.

Small gastric GISTsGastrointestinal stromal tumours arising from the muscle layer, within the size range suitable for endoscopic removal.
Other subepithelial tumoursLeiomyoma, schwannoma and similar lesions confirmed on endoscopic ultrasound. Non-lifting lesionsMucosal lesions that will not lift because of scarring from previous resection or treatment.
Difficult sitesLesions at the appendiceal orifice or a diverticulum where standard resection is unsafe.

EFTR belongs to third-space endoscopy, the same family of techniques as POEM and ESD. Deciding between them starts with an endoscopic ultrasound to establish which layer the lesion arises from.

The procedure

How EFTR is performed

  1. EUS assessment — endoscopic ultrasound establishes the layer of origin, the size and the growth pattern
  2. Planning — the case is discussed with surgery where the size or site makes endoscopic removal marginal
  3. Resection — the lesion is dissected and removed through the full thickness of the wall
  4. Closure — the defect is closed from inside with clips, an over-the-scope clip or endoscopic suturing
  5. Recovery — a short hospital stay with observation, antibiotics and a staged diet

When surgery is the better option

Size and site matter. A large GIST, a lesion with features suggesting higher-risk behaviour, or one arising where the wall cannot be closed reliably is better dealt with surgically.

EFTR creates a controlled hole in the gut wall and closes it. That is safe in trained hands and with the right case selection, and unwise without both.

These decisions are made jointly with the surgical and oncology teams rather than in a single endoscopy clinic. If surgery is the safer option for you, that is what will be recommended.

Related

Related procedures

Advanced & third-space endoscopyThe full range of advanced endoscopic procedures performed by Dr Surakshith T K in Delhi. EUSEstablishes which layer a subepithelial lesion arises from. ESDFor lesions confined to the lining and submucosa. POEMThird-space myotomy for achalasia cardia. EMRResection of superficial mucosal lesions. Upper GI endoscopyWhere most subepithelial lesions are first noticed.

A subepithelial lesion or GIST found on your endoscopy?

Send the endoscopy report, EUS if it has been done, and any CT images. The first question is which layer it comes from — that decides whether it can be removed endoscopically at all.

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  • +91 96861 37977
  • Kalka Gastro Liver & Obesity Clinic10/22 Nehru Enclave East, Kalkaji, New Delhi 110019
  • Mon–Sat, 5:00 pm – 8:30 pmProcedures at Fortis Escorts (Okhla) & Holy Family (NFC)

FAQ

Frequently asked questions

What is a GIST, and does it always need surgery?

A gastrointestinal stromal tumour is a growth arising from the muscle layer of the stomach or intestine. Small GISTs in selected positions can be removed endoscopically by EFTR; larger ones, and those with higher-risk features, are treated surgically. Endoscopic ultrasound and imaging decide which group a particular tumour falls into.

Is EFTR safe?

EFTR deliberately creates a full-thickness defect in the gut wall and then closes it endoscopically. In appropriately selected patients and in trained hands it is a safe procedure with a short hospital stay. Case selection is what makes it safe, which is why the assessment beforehand matters as much as the procedure.

How long is the recovery after EFTR?

Most patients stay in hospital for one to three days, starting with liquids and moving to a soft diet, and return to ordinary activity within one to two weeks. There is no external wound to heal.

Dr Surakshith T K, gastroenterologist and advanced therapeutic endoscopist in Delhi
Medical author & reviewer: Dr Surakshith T K
  • MBBS · MD (Medicine) · DNB (Gastroenterology & Hepatology), Sir Ganga Ram Hospital
  • Senior Consultant Gastroenterologist, Hepatologist & Therapeutic Endoscopist
  • 250+ third-space procedures · 200+ POEM · 10,000+ ERCP · 5,000+ EUS
  • Fortis Escorts Hospital, Okhla · Holy Family Hospital, New Delhi · Kalka Gastro Liver & Obesity Clinic, Kalkaji
  • Delhi Medical Council reg. 74686

This page is for general information and does not replace an individual consultation. Whether a procedure is suitable depends on your own reports and examination. Last reviewed September 2026.