Outcomes of Endoscopic Full Thickness Resection in the Colon Rectum at an Italian Tertiary Center

Overview

Journal Tech Coloproctol

Date 2023 May 19

PMID 37204474

Authors

F Cavalcoli

A Magarotto

M E Kelly

P Cantu

A Mancini

E Rausa

E Masci

Affiliations

Soon will be listed here.

Abstract

Purpose: Endoscopic full-thickness resection (EFTR) is an innovative technique for the treatment of colonic lesions not feasible by conventional endoscopic resection. Here, we aimed to evaluate the efficacy and safety of a Full-Thickness Resection Device (FTRD) for colonic lesions in a high-volume tertiary referral center.

Methods: A review of a prospectively collected database on patients that underwent EFTR with FTRD for colonic lesions from June 2016 to January 2021 at our institution was performed. Data regarding the clinical history, previous endoscopic treatments, pathological examination, technical and histological success, and follow-up were evaluated.

Results: Thirty-five patients (26 males, median age 69 years) underwent FTRD for colonic lesion. Eighteen lesions were in the left colon, three in the transverse, and 12 in the right colon. The median size of the lesions was 13 (range 10-40) mm. Resection was technically successful in 94% of patients. The mean hospital stay was 3.2 (SD ± 1.2) days. Adverse events were reported in four cases (11.4%). Histological complete resection (R0) was achieved in 93.9% of cases. Endoscopic follow-up was available in 96.8% of patients, at a median duration of 14.6 months (3-46 months). Recurrence was observed in 19.4% of cases at a median time of 3 months (3-7 months). Five patients had multiple FTRD performed, with R0 resection in three cases. In this subset, adverse events were observed in 40% of cases.

Conclusions: FTRD is safe and feasible for standard indication. The non-negligible rate of recurrence observed suggests the need for close endoscopic follow-up in these patients. Multiple EFTR could help achieve complete resection in selected cases; however, in this setting, a higher risk of adverse events was observed.

References

Mizushima T, Kato M, Iwanaga I, Sato F, Kubo K, Ehira N . Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc. 2014; 29(1):133-9. DOI: 10.1007/s00464-014-3665-9. View

Boger P, Rahman I, Hu M, Ayaru L, Bhandari P, Chedgy F . Endoscopic full thickness resection in the colo-rectum: outcomes from the UK Registry. Eur J Gastroenterol Hepatol. 2020; 33(6):852-858. DOI: 10.1097/MEG.0000000000001987. View

Andrisani G, Di Matteo F . Hybrid resection with ESD and FTRD: Could this be a rescue treatment in the presence of severe submucosal fibrosis?. Dig Liver Dis. 2019; 51(4):607-609. DOI: 10.1016/j.dld.2019.01.003. View

Mahadev S, Vareedayah A, Yuen S, Yuen W, Koller K, Haber G . Outcomes of a hybrid technique using EMR and endoscopic full-thickness resection for polyps not amenable to standard techniques (with video). Gastrointest Endosc. 2021; 94(2):358-367.e1. DOI: 10.1016/j.gie.2021.02.009. View

Meier B, Caca K, Schmidt A . Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video). Surg Endosc. 2017; 31(10):4268-4274. DOI: 10.1007/s00464-017-5461-9. View

Aepli P, Criblez D, Baumeler S, Borovicka J, Frei R . Endoscopic full thickness resection (EFTR) of colorectal neoplasms with the Full Thickness Resection Device (FTRD): Clinical experience from two tertiary referral centers in Switzerland. United European Gastroenterol J. 2018; 6(3):463-470. PMC: 5949966. DOI: 10.1177/2050640617728001. View

Meier B, Stritzke B, Kuellmer A, Zervoulakos P, Huebner G, Repp M . Efficacy and Safety of Endoscopic Full-Thickness Resection in the Colorectum: Results From the German Colonic FTRD Registry. Am J Gastroenterol. 2020; 115(12):1998-2006. DOI: 10.14309/ajg.0000000000000795. View

Zwager L, Bastiaansen B, Bronzwaer M, van der Spek B, Heine G, Haasnoot K . Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry. Endoscopy. 2020; 52(11):1014-1023. DOI: 10.1055/a-1176-1107. View

Brewer Gutierrez O, Akshintala V, Ichkhanian Y, Brewer G, Hanada Y, Truskey M . Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis. Endosc Int Open. 2020; 8(3):E313-E325. PMC: 7035039. DOI: 10.1055/a-1073-7593. View

10.

Li P, Ma B, Gong S, Zhang X, Li W . Efficacy and safety of endoscopic full-thickness resection in the colon and rectum using an over-the-scope device: a meta-analysis. Surg Endosc. 2020; 35(1):249-259. DOI: 10.1007/s00464-020-07387-w. View

11.

Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag H, Messmann H . Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut. 2017; 67(7):1280-1289. DOI: 10.1136/gutjnl-2016-313677. View

12.

Valli P, Kaufmann M, Vrugt B, Bauerfeind P . Endoscopic resection of a diverticulum-arisen colonic adenoma using a full-thickness resection device. Gastroenterology. 2014; 147(5):969-71. DOI: 10.1053/j.gastro.2014.07.053. View

13.

van der Spek B, Haasnoot K, Meischl C, Heine D . Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety. Endosc Int Open. 2018; 6(10):E1227-E1234. PMC: 6175680. DOI: 10.1055/a-0672-1138. View

14.

Schmidt A, Bauerfeind P, Gubler C, Damm M, Bauder M, Caca K . Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy. 2015; 47(8):719-25. DOI: 10.1055/s-0034-1391781. View

15.

Kuellmer A, Mueller J, Caca K, Aepli P, Albers D, Schumacher B . Endoscopic full-thickness resection for early colorectal cancer. Gastrointest Endosc. 2019; 89(6):1180-1189.e1. DOI: 10.1016/j.gie.2018.12.025. View

16.

Vitali F, Naegel A, Siebler J, Neurath M, Rath T . Endoscopic full-thickness resection with an over-the-scope clip device (FTRD) in the colorectum: results from a university tertiary referral center. Endosc Int Open. 2018; 6(1):E98-E103. PMC: 5770264. DOI: 10.1055/s-0043-124079. View

17.

Soriani P, Tontini G, Neumann H, de Nucci G, de Toma D, Bruni B . Endoscopic full-thickness resection for T1 early rectal cancer: a case series and video report. Endosc Int Open. 2017; 5(11):E1081-E1086. PMC: 5659870. DOI: 10.1055/s-0043-118657. View

18.

Mao de-Ferro S, Castela J, Pereira D, Chaves P, Dias Pereira A . Endoscopic Full-Thickness Resection of Colorectal Lesions with the New FTRD System: Single-Center Experience. GE Port J Gastroenterol. 2019; 26(4):235-241. PMC: 6624659. DOI: 10.1159/000493808. View