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

Abstract

Introduction Endoscopic full-thickness resection (eFTR) using the full-thickness resection device (FTRD®) is a novel minimally invasive procedure that allows the resection of various lesions in the gastrointestinal tract including the colorectum. Real-world data outside of published studies are limited. The aim of this study was a detailed analysis of the outcomes of colonoscopic eFTR in different hospitals from different care levels in correlation with the number of endoscopists performing eFTR. Material and methods In this case series, the data of all patients who underwent eFTR between November 2014 and June 2019 (performed by a total of 22 endoscopists) in 7 hospitals were analyzed retrospectively regarding rates of technical success, R0 resection, and procedure-related complications. Results Colonoscopic eFTR was performed in 229 patients (64.6% men; average age 69.3 ± 10.3 years) mainly on the basis of the following indication: 69.9% difficult adenomas, 21.0% gastrointestinal adenocarcinomas, and 7.9% subepithelial tumors. The average size of the lesions was 16.3 mm. Technical success rate of eFTR was achieved in 83.8% (binominal confidence interval 78.4-88.4%). Overall, histologically complete resection (R0) was achieved in 77.2% (CI 69.8-83.6%) while histologically proven full-wall excidate was confirmed in 90.0% (CI 85.1-93.7%). Of the resectates obtained (n = 210), 190 were resected en bloc (90.5%). We did not observe a clear improvement of technical success and R0 resection rate over and Other Interventional Techniques Parts of the data have already been presented as a lecture at the annual meetings of the DGVS 2018 and 2019 and published as an abstract (I Krutzenbichler, M Fuchs, B Lewerenz, T Leimbach, A Nehrlich, W Schepp, F Gundling. Application of endoscopic full-wall resection using the "full-thickness resection device" (FTRD®) regarding technical success rate and procedural complications-a single-center study,

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

“…Because of the limited sample size, we were unable to perform multivariate analysis to adjust for possible confounders; therefore, future prospective studies with a larger sample size are required to confidently report the factors that are associated with post-EFTR appendicitis. Nonetheless, these results are a significant addition to the currently available scant evidence, which consists mostly of very small case series that have not identified the risk factors for appendicitis 10 11 12 13 14 15 16 17 18 19 20 21 .…”

“…Villous Adenoma 1Sessile Serrated Adenoma (19) Hyperplastic Polyp 4Endometriosis 1Tubular Adenoma 2Sessile Serrated Adenoma 4Adenoma with High Grade Dysplasia 2Adenocarcinoma 1Hyperplastic Polyp 1-* EFTR was completed and had no prior history of appendectomy; ** OR with 95%CI from univariable logistic regression models Lateral spreading of the lesion beyond the appendiceal orifice, n (%)…”

“…However, post-EFTR appendicitis remains a major concern, with different studies reporting inconsistent results, with an incidence ranging from 0% to 50% of the cases. [10][11][12][13][14][15][16][17][18][19][20][21] The literature on the use of FTRD for managing appendiceal polyps remains limited to small sub-cohorts in studies looking into the general outcomes of FTRD for colorectal lesions. [10][11][12][13][15][16][17][18][19][20][21][22] Hence, comprehensive analysis on this specific use of FTRD, and identifying risk as well as protective factors, notably the use of antibiotics, associated with post-resection…”

“…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.…”