Efficacy and Safety of Full-thickness Resection Device (FTRD) for Colorectal Lesions Endoscopic Full-thickness Resection

Abstract

Background and Aims: Endoscopic full-thickness resection (eFTR) is a field of increasing interest that offers a minimally invasive resection modality for lesions that are not amenable for resection by conventional methods. Full-thickness resection device (FTRD) is a new device that was developed for a single-step eFTR using an over-the scope-clip. In this meta-analysis, we aim to assess the efficacy and safety of FTRD for eFTR of colorectal lesions. Methods: A Comprehensive literature review of different databases to identify studies reporting FTRD with outcomes of interest was performed. Studies with <10 cases were excluded. Rates of histologic complete resection (R0), technical success, and complications were extracted. Efficacy was assessed by using the technical and the R0 rates whereas safety was assessed by using the complications rates. Weighted pooled rates (WPRs) and the 95% confidence interval (CI) were calculated depending on the heterogeneity (I 2 statistics). Results: Nine studies including 551 patients with 555 lesions were included in this study. The WPR for overall R0 was 82.4% (95% CI: 79.0%-85.5%),with moderate heterogeneity (I 2=34.8%). The WPR rate for technical success was 89.25% (95% CI: 86.4%-91.7%), with low heterogeneity (I 2=23.7%). The WPR for total complications rate was 10.2% (7.8, 12.8%) with no heterogeneity. The pooled rate for minor bleeding, major bleeding, postpolypectomy syndrome, and perforation were 3.2%, 0.97%, 2.2%, and 1.2%, respectively. Of 44 periappendicular lesions, the pooled rate for acute appendicitis was 19.7%. Conclusions: FTRD seems to be effective and safe for eFTR of difficult colorectal lesions. Large prospective studies comparing FTRD with conventional resection techniques are warranted.

Endoscopic Full Thickness Resection: A Systematic Review

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“…51 R0 resection did not differ based on indication (difficult adenoma, early carcinoma, and SELs) or location (proximal, distal colon, and rectum). 52 Two meta-analyses evaluating only FTRD have shown that success of insertion to target lesion, technical success, R0 resection, total complication rates were 96.1%, 89 to 90, 78 to 82, and 8 to 10%, respectively. Major bleeding, perforation, and need for emergent surgery occurred in roughly 1% cases whereas post-polypectomy syndrome was noted in 2%.…”

“…Major bleeding, perforation, and need for emergent surgery occurred in roughly 1% cases whereas post-polypectomy syndrome was noted in 2%. 52 53…”

“…Major bleeding, perforation, and need for emergent surgery occurred in roughly 1% cases whereas post-polypectomy syndrome was noted in 2%. 52,53 EFTR for Early Colorectal Cancer (CRC) EFTR using FTRD device or EFTR with endoscopic lymphadenectomy has been described for superficial CRC. While many techniques are limited to case reports/series, 156 cases of adenocarcinoma detected incidentally on histology after resection using FTRD were described by Kuellmer et al 54 The R0 resection rate was lower in nonlifting lesion (61%) as compared with polypoidal lesion (87.5%).…”

Use of endoscopic sleeve to achieve full-thickness endoscopic resection of malignant polyp under direct vision

“…Surgical colectomy is associated with a low rate of residual cancer, but significant morbidity. In select patients, endoscopic full-thickness resection (EFTR) may be an option [2,3]. We report EFTR using an endoscopic sleeve (Dilumen; Lumendi) with multiple endoscopic tools.…”