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A new device for full-thickness colorectal resection, the so-called full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany) has been available since November of 2014. It is the first commercial system based on the overthe-scope clip (OTSC) principle. The FTRD consists of a modified 14t OTSC mounted on a transparent cap, which has amonofilament polypectomy snare preloaded on its tip. The FTRD can be mounted over a standard colonoscope [1]. Because the volume of the transparent FTRD cap is greater than that of the OTSC cap (3cm3 vs. 0.9cm3), full-thickness specimens with a median resection surface of 5cm2 (range 1.6cm2–12.9cm2) can be obtained [2]. A 59-year old patient was referred for further treatment after incomplete polypectomy of a large rectal polyp. Histologically, a tubulovillous adenoma harboring high grade dysplasia was described. The index endoscopic procedure demonstrated a villous polyp in the rectosigmoid curve that was difficult to visualize. With a mounted transparent distance cap (MAJ663; Olympus, Tokyo, Japan), better visualization was possible, and a large, broadbased villous polyp remnant about 3cm in diameter was seen (●" Fig.1). After the patient had provided informed consent, polypectomy of the polyp remnant was performed close to its base with a standard snare (FlexSnare; Medwork, Höchstadt/Aisch, Germany; ●" Fig.2). Then, the FTRDwasmounted on a colonoscope (CF-H180AI, Olympus), and a fullthickness resection of the entire polypectomy site was carried out uneventfully (●" Fig.3). The snare polypectomy remnant and the FTRD specimen measured 3×2×1cm and 3.1×2.5×0.8cm, respecFig.3 Resection with the full-thickness resection device (FTRD). a The polypectomy site with visible small remnants of the polyp is pulled into the FTRD cap with the grasper (asterisk) included in the package. The polypectomy snare is preloaded on the FTRD cap (cross), and an over-the-scope clip (OTSC; arrow) is also loaded on the FTRD cap.b Full-thickness resection site with the OTSC in situ. Fig.2 Endoscopic view of the polyp base after snare resection. The lateral margins of small polyp remnants (asterisks) have been marked with the coagulation probe (arrows) included in the package of the full-thickness resection device. Fig.1 Flexible endoscopy in a 59-year old woman referred for further treatment after incomplete polypectomy of a large rectal polyp, described as a tubulovillous adenoma harboring high grade dysplasia. aWith a standard colonoscope, only part of the polyp remnant is visible. b Visualization of the true extent of the polyp remnant is improved with the mounted distance cap.

Resection of a large rectal polyp with the simultaneous combination of snare polypectomy and full-thickness resection device resection