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. Methods We 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. Conclusions Our 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.

Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

“…The FTRD system accommodates lesions with a maximum diameter of 30 mm [16]. In contrast to Schmidt and colleagues, we did not find a significant difference in the R0 resection rate between lesions > 20 mm (72.7 %) vs. lesions ≤ 20 mm (78.3 %; P = 0.71) [3,11]. However, our subgroup of lesions larger > 20 mm is relatively small and might have biased our results.…”

“…However, we included mainly recurrent lesions after previously incomplete resections. As mentioned, submucosal scarring can limit adequate tissue mobilization into the cap [6,11]. From our experience, mobilization of recurrent lesions after previous EMR can be challenging.…”

Technical success, resection status, and procedural complication rate of colonoscopic full-wall resection: a pooled analysis from 7 hospitals of different care levels

“…Procedure-related, mostly moderate complications were observed in 17.5% including 2 cases of acute gangrenous appendicitis requiring operation. Real-world data of eFTR performed by endoscopists in hospitals with a lower level of care and outside of published studies are rare [21][22][23][24][25][26][27][28][29]. In particular, it is not clear whether the positive results of the published studies obtained in referral centers can be transferred to the performance quality in other hospitals.…”

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

“…There are three devices designed for endoscopic defect closure in EFTR procedure with unique techniques respectively. After the colonic lesion was endoscopically marked, it was maneuvered into the resection chamber, using either traction or suction, of the full-thickness resection device (FTRD; Ovesco Endoscopy, Tubingen, Germany) (37,38). The tissue fold was then excised and a stapled anastomosis was resulted.…”