Adverse Events of Endoscopic Full-Thickness Resection: Results From the German and Dutch Colorectal Eftr Registry

Zwager, Liselotte W.; Müeller, Jens-Dominik; Stritzke, B.; Montazeri, Nahid S.M.; Caca, Karel; Dekker, Evelien; Fockens, Paul; Schmidt, A.; Bastiaansen, Baj

doi:10.1055/s-0042-1744852

Cited by 4 publications

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“…If no border of the lesion is visible, an eFTR could be considered. The downside of eFTR is an 8.8 %–20 % rate of secondary post-procedural appendicitis 21 22 ; however, it is important to emphasize that only two-thirds of the appendix is resected by eFTR, limiting complete resection of a deeply growing intra-appendiceal polyp. The final option is a conventional appendectomy in which the surgeon includes a small part of the cecum.…”

Section: Discussionmentioning

confidence: 99%

Appendiceal lesions in serrated polyposis patients are easily overlooked but only seldomly lead to colorectal cancer

et al. 2023

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Background Serrated polyposis syndrome (SPS) is the most prevalent colonic polyposis syndrome and is associated with an increased colorectal cancer risk. A recent study in resected appendices of SPS patients reported that 6/23 (26.1 %) of identified serrated polyps had histological dysplasia. We evaluated the prevalence and clinical relevance of appendiceal lesions in a large SPS cohort. Methods Prospective data from 2007 to 2020 for a cohort of 199 SPS patients were analyzed. Data were retrieved from endoscopy and pathology reports. Patients who underwent (pre)clearance colonoscopies, surveillance colonoscopies, or colorectal surgery including the appendix were separately evaluated for the presence of appendiceal lesions. The primary outcome was the prevalence of adenocarcinomas and serrated polyps/adenomas with advanced histology in the surgery group. Results 171 patients were included, of whom 110 received endoscopic surveillance and 34 underwent surgery. Appendiceal lesion prevalence in the surgery group was 14 /34 (41.2 %, 95 %CI 24.7 %–59.3 %); none were advanced on histology. Detection rates in the (pre)clearance group were 1 /171 (0.6 %, 95 %CI 0.01 %–3.2 %) for advanced and 3 /171 (1.8 %, 95 %CI 0.04 %–5.0 %) for nonadvanced appendiceal lesions, all of which were sessile serrated lesions. During 522 patient-years of surveillance, no advanced appendiceal lesions were detected at endoscopy, and in 1 /110 patients (0.9 %, 95 %CI 0.02 %–5.0 %) was a nonadvanced lesion detected. Conclusion Appendiceal lesions are common in SPS patients. The discrepancy between the endoscopic detection rate of appendiceal lesions and the reported prevalence in surgically resected appendices suggests a substantial miss-rate of appendiceal lesions during colonoscopy. Advanced appendiceal lesions are however rare and no appendiceal adenocarcinomas occurred, implying limited clinical relevance of these lesions.

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Section: Discussionmentioning

confidence: 99%

Appendiceal lesions in serrated polyposis patients are easily overlooked but only seldomly lead to colorectal cancer

et al. 2023

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“…eFTR has emerged as a very promising new excision tool, especially for T1 CRCs with deep submucosal invasion (T1b). It is relatively easy to apply and less difficult to learn compared with ESD; however, the perforation risk is not inconsiderable, the device is more expensive, and long-term follow-up data are still lacking 18 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Limited data suggest that eFTR also has the potential to facilitate an en bloc R0 resection for malignant colorectal polyps. The same group reported an R0 resection rate of 60.9 % in 92 eFTRs for colon cancers with a median lesion size of 20 mm, while a Dutch registry demonstrated a higher R0 rate of 77.9 % in 71 eFTRs for suspected T1 CRC with a median size of 13 mm 19 20 .…”

Section: Introductionmentioning

confidence: 93%

Relevance of polyp size for primary endoscopic full-thickness resection of suspected T1 colorectal cancers

et al. 2022

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Background and study aims En-bloc local excision of suspected T1 colorectal cancer (CRC) provides optimal tumor risk assessment with curative intent. Endoscopic full-thickness resection (eFTR) with an over-the-scope device has emerged as a local excision technique for T1CRCs, but data on the upper size limit for achieving a histological complete resection (R0) are lacking. We aimed to determine the influence of polyp size on R0 rate. Patients and methods eFTR procedures for suspected T1CRCs performed between 2015-2021, were selected from endoscopy databases of three tertiary centers. Main outcome was R0, defined as a tumor and dysplasia free margin (≥0.1 mm) for both deep and lateral resection margins. Regression analysis was performed to identify risk factors for a R1/x, mainly focusing on endoscopic estimated polyp size. Results In total 136 patients underwent an eFTR for a suspected T1CRC (median size 15 mm, IQR 13-18 mm; 83.1% cancer). Technical success and R0 rates were 87.5% (119/136, 95% CI 80.9-92.1%) and 79.7% (106/136, 95% CI 72.1-85.7%) respectively. Increasing polyp size was significantly associated with R1/x resection (RR 2.35 per 5 mm increase, 95% CI 1.80-3.07, p<0.001). R0 rate was 89.9% (80/89) for polyps ≤ 15 mm, 71.4% (25/35) for 16-20 mm, and 11.1% (1/9) for >20 mm. Conclusions eFTR is associated with a 90% R0 rate for T1CRCs ≤15 mm. Performing eFTR for polyps 16-20 mm should depend on access, mobility and availability of alternative resection techniques. eFTR for >20 mm polyps results in a high R1 rate and should not be recommended.

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“…ESD with traction systems 16 seems to successfully expose the submucosa and allow resection of the lesion as close to the muscle as possible to obtain an adequate deep margin. Full-thickness resection with the full-thickness resection device (FTRD) system is an alternative to obtain a deeper resection when the overall size of the lesion is < 20 mm 17 ; however, a size < 20 mm is rare for these relatively advanced lesions. A newer option, endoscopic intermuscular resection, allows the whole thickness of the submucosa to be reached, but data are needed to demonstrate its efficacy and safety 18 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion

et al. 2022

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Introduction: Endoscopic submucosal dissection (ESD) is potentially a curative treatment of T1 colorectal cancer in certain condition. The aim of the study was to evaluate the feasibility and effectiveness of ESD on lesions with suspicion of focal deep invasion. Methods: In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying focal (< 15 mm) deep invasive patterns (FDIP) treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). Results: A total of 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 (95.2%) cases. When possible, En bloc and R0 resection rate were respectively 95.8% (115/120) and 76.7% (92/120). Thirty-three (26.2%) resections were treated curatively for very low risk tumors and 38 (30.2%) were considered as low risk. Non-curative R0 resections concerned lesions with lymphatic or vascular invasion (LVI) (n=8), or significant budding (n=9), and LVI + budding association (n=4). Conclusion: ESD is feasible and safe for colorectal lesions with FDIP ≤ 15 mm. It cured 26.2% of patients and could be a valid option for 30.2% of additional patients with low-risk T1 cancers, especially for fragile patients with comorbidities.

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Adverse Events of Endoscopic Full-Thickness Resection: Results From the German and Dutch Colorectal Eftr Registry

Cited by 4 publications

References 0 publications

Appendiceal lesions in serrated polyposis patients are easily overlooked but only seldomly lead to colorectal cancer

Appendiceal lesions in serrated polyposis patients are easily overlooked but only seldomly lead to colorectal cancer

Relevance of polyp size for primary endoscopic full-thickness resection of suspected T1 colorectal cancers

Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion

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