Treatment of neoplastic colonic lesions using the full-thickness resection device

Abstract

Background and Aims: Advanced adenomas and scarred lesions pose difficulties for the endoscopist because of the need for complete resection and accurate pathologic staging, which cannot be afforded by standard resection techniques. Endoscopic full-thickness resection, first described in Europe for treatment of early adenocarcinoma or scarred lesions in the colon, allows potentially curative en bloc resection in patients who may be at a high risk for surgery. We describe our endoscopic approach and histologic outcomes with use of a commercially available endoscopic full-thickness resection device (FTRD) (Ovesco Endoscopy, Tubingen, Germany). Methods: We report our experience using the FTRD for advanced polyps in patients referred to our tertiary care center. Three patients were identified from a prospectively maintained database of patients undergoing FTRD from December 2018 to February 2019. Demographic, endoscopic, and histologic data were collected. Results: All patients underwent successful full-thickness resection of the adenocarcinoma, and histopathologic examination showed negative lateral and deep margins. No immediate or delayed adverse events occurred during an average 2-month follow-up period. Conclusions: Full-thickness resection with an over-the-scope fitted FTRD is safe and effective in the management of advanced colonic neoplastic lesions.

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.…”

Challenging full-thickness resection of post endoscopic mucosectomy residual scar in right colon, accessed via a balloon-dilated stoma

“…In recent years, the spectrum of endoscopic colorectal resection methods for mucosal carcinomas and scar lesions that show no lifting sign has been extended by the use of full-thickness resection (FTR) 1 .…”

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]. 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].…”