Endoscopic Full Thickness Resection of Colorectal Lesions With the Full Thickness Resection Device: Clinical Experience From Two Referral Centers in Greece

Abstract

Background Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD  ) is an invasive treatment for colorectal lesions not resectable by conventional endoscopic techniques. This study presents the first Greek experience of the FTRD  procedure, assessing the efficacy and safety of EFTR. MethodsWe conducted a retrospective analysis of 17 consecutive patients treated with the FTRD  at 2 referral centers from October 2015 through December 2018. The indications included difficult adenomas (non-lifting and/or at difficult locations), early adenocarcinomas and subepithelial tumors. Primary endpoints were technical success and R0 resection.Results Technical success and R0 resection were achieved in 82.3% procedures (14/17) and in 87.5% of those with difficult adenomas (8 patients). In the subgroup with carcinomas (n=3), the rate of technical success and R0 resection was 66.6%, while in the subgroup with subepithelial tumors (n=6) the rate was 83.3%. Technical success and R0 resection were significantly lower for lesions >20 mm vs. ≤20 mm (P=0.0429). In the 17 patients a total of 3 adverse events occurred (17.6%) and one of the patients underwent laparoscopic appendectomy because of EFTR around the appendix. ConclusionsOur study showed favorable results concerning EFTR feasibility, efficacy and safety, especially for lesions ≤20 mm, non-lifting adenomas, and subepithelial tumors. Technical success, R0 resection, and adverse events rates were comparable with previously published data. Larger randomized studies are needed to better define the clinical benefit and long-term outcomes of EFTR in selected patients.

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].…”

Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience

“…This could be especially beneficial for patients who are poor surgical candidates. However, post-EFTR appendicitis remains a major concern, with different studies reporting inconsistent results and incidence rates ranging from 0 % to 50 % 10 11 12 13 14 15 16 17 18 19 20 21 .…”

“…The literature on the use of the FTRD for managing appendiceal polyps remains limited to small subcohorts in studies looking at the general outcomes of the FTRD for colorectal lesions 10 11 12 13 15 16 17 18 19 20 21 22 . To date, there has been no comprehensive analysis on this specific use of the FTRD, and the potential risk factors and protective factors (notably the use of antibiotics) associated with post-resection appendicitis remain unknown.…”