Endoscopic full thickness resection (EFTR) of colorectal neoplasms with the Full Thickness Resection Device (FTRD): Clinical experience from two tertiary referral centers in Switzerland

Abstract

Background: Endoscopic full thickness resection (EFTR) by the Full Thickness Resection Device (FTRD) has recently been introduced as a method to allow resection of certain lesions such as adenomatous polyps that would not be resectable by standard polypectomy techniques. We report our clinical experience with FTRD procedures, assessing technical success, completeness of resection (R0 status), rate of histologically proven FTR and safety. Patients and methods:We conducted a retrospective analysis of 33 consecutive patients with colonic polyps treated with FTRD from May 2015 to November 2016. Results: Indications mainly were adenoma recurrence or residual adenoma with nonlifting sign after previous polypectomy. In the 31 cases amenable to EFTR, resection was en bloc and histologically complete (R0) in 87.9% (29/33) of patients. Histologically confirmed complete full thickness resection (FTR) was achieved in 80.6% (25/31). Three post-procedure bleedings and one perforation were seen. Conclusion: FTRD offers an additional endoscopic approach to treat nonlifting colorectal lesions. EFTR by FTRD appears to be feasible and efficacious in the resection of benign neoplasms of up to 30 mm in diameter and may be an alternative to surgery in selected patients. Given a significant rate of complications, safety is a concern and needs to be assessed in larger prospective studies.

Simultaneous endoscopic full-thickness resection of two synchronous colonic granular cell tumours

“…The most feared complication is an anastomotic leak and consequently perforation. In a small retrospective study, the perforation rate was low, but not negligible with up to 3% 20. Another study did not show any perforations 19.…”

Dissection-enabled scaffold-assisted resection (DeSCAR): a novel technique for resection of residual or non-lifting gastrointestinal neoplasia of the colon, expanded experience and follow-up

“…Endoscopic full-thickness resection (EFTR) is a newer technique wherein an over-the-scope clip is deployed over an adequately grasped/suctioned lesion (typically through a transparent cap), and the lesion is subsequently removed with a snare [34][35][36][37][38][39]. The technical success of EFTR for benign, recurrent adenomas with non-lifting sign, advanced histopathological findings, or submucosal involvement approached 75 % to 100 % and histologically complete resection (R0) rates of 80 % to 93 % has led to curative resection of advanced benign and malignant lesions, obviating the need for surgery, particularly for lesions limited to the superficial submucosa without evidence of lymphovascular invasion or poor grade of differentiation [35][36][37][38][39]. Applied to previously manipulated lesions, R0 resection rates approach 89 % [35][36][37][38][39].…”

“…The technical success of EFTR for benign, recurrent adenomas with non-lifting sign, advanced histopathological findings, or submucosal involvement approached 75 % to 100 % and histologically complete resection (R0) rates of 80 % to 93 % has led to curative resection of advanced benign and malignant lesions, obviating the need for surgery, particularly for lesions limited to the superficial submucosa without evidence of lymphovascular invasion or poor grade of differentiation [35][36][37][38][39]. Applied to previously manipulated lesions, R0 resection rates approach 89 % [35][36][37][38][39]. However, while surgery can be avoided in many cases in which EFTR is used, R0 resection rates are lower for lesions greater than 2 cm in size (33 %-87 %) and those that contain adenocarcinoma (67 %), and a total complication rate of 5 %-15 % was observed in studies published to date [34][35][36][37][38][39].…”

“…Applied to previously manipulated lesions, R0 resection rates approach 89 % [35][36][37][38][39]. However, while surgery can be avoided in many cases in which EFTR is used, R0 resection rates are lower for lesions greater than 2 cm in size (33 %-87 %) and those that contain adenocarcinoma (67 %), and a total complication rate of 5 %-15 % was observed in studies published to date [34][35][36][37][38][39]. A hybrid EMR-EFTR techniquewherein the lifting portions of the lesion are removed by EMR and the nonlifting portions removed by EFTRwas developed to address the size limitation of EFTR and was applied to colonic lesions with a median size of 35.5 mm with 100 % R0 resection rate, no residual or recurrent adenoma at 3-month follow up, and no reported complications [40].…”

Perforation als Spätkomplikation nach endoskopischer Vollwandresektion eines Rezidivadenoms im Colon sigmoideum

“…Bei den in der Literatur beschriebenen Perforationen nach erfolgter Vollwandresektion mittels FTRD ® lässt sich bislang ein Zusammenhang zwischen Device-Defekten [4,10], erschwerter anatomischer Lage bei in einem Divertikel gelegenem Polypen [5] oder auch vorbestehender immunsuppressiver Therapie mit dadurch erhöhtem Komplikationsrisiko nachweisen [7].…”