Endoscopic full-thickness resection (EFTR) has emerged as an advanced minimally invasive technique that extends the therapeutic spectrum of interventional endoscopy. By enabling en bloc resection of subepithelial tumors and complex lesions not amenable to conventional endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), EFTR provides both diagnostic and therapeutic value. The cornerstone of this procedure is the use of over-the-scope (OTS) clips, which not only secure the resection site but also facilitate controlled and safe full-thickness excision.
This presentation will outline the principles, indications, and technical steps of EFTR, with emphasis on the role of OTS clips in maintaining tissue apposition, minimizing adverse events, and ensuring reliable closure of gastrointestinal wall defects. Current evidence highlights favorable outcomes in selected lesions of the colon, rectum, and stomach, where surgical alternatives may carry higher morbidity. Practical aspects such as patient selection, device handling, and complication management will be reviewed, alongside illustrative clinical cases.
The talk aims to provide clinicians with a comprehensive overview of EFTR, underscore the expanding role of OTS clips in endoscopic innovation, and highlight how these advances are reshaping therapeutic strategies within modern gastrointestinal endoscopy.

Endoscopy continues to evolve as both a diagnostic and therapeutic tool, offering clinicians the ability to address complex gastrointestinal conditions with precision and minimal invasiveness. Among the most dynamic areas are endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), which play a central role in managing hepatobiliary and pancreatic disorders. While guidelines provide structured approaches, real-world practice frequently presents unique and unexpected challenges that require individualized strategies.
This session will showcase a selection of unusual and thought-provoking cases encountered in daily practice, highlighting the decision-making process, technical innovations, and lessons learned. Additional examples from diagnostic and therapeutic endoscopy will be presented, emphasizing the creativity and adaptability required in advanced endoscopic practice.
The aim of this talk is to share clinical experience, stimulate discussion, and provide practical insights into handling challenging cases. By exploring these real-world situations, participants will gain a broader perspective on endoscopic problem-solving and the evolving role of advanced techniques in patient care.