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A systematic review regarding the feasibility and safety of endoscopic full thickness resection (EFTR) for colonic lesions

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Abstract

Purpose

This review summarizes the published methods of colonic EFTR, examining data on feasibility and safety. Due to the introduction of bowel cancer screening programs, there is an increasing incidence of complex colonic polyps and early colonic cancer that requires segmental colectomy. Traditional radical surgery is associated with significant morbidity, and there is a need for alternative treatments.

Methods

Systematic literature search identified articles describing EFTR techniques of colon, published between 1990 and 2012. Complication rates, anastomotic bursting pressures, procedure duration, specimen size and quality, and postmortem findings were analyzed.

Results

Five research groups reported four EFTR techniques using endoscopic stapling devices, T-tags, compression closure, or laparoscopic assistance for defect closure before or after specimen resection. A total of 113 procedures were performed in 99 porcine models, with an overall success rate of 89 and 4 % mortality. The intraoperative complication rate was 22 % (0–67 %). Post-resection closure methods more commonly resulted in failure to close the defect (5–55 %) and a high incidence of abnormal findings at postmortem examination (84 %). Significant heterogeneity was observed in procedure duration (median or mean 3–233 min) and size of the excised specimen (median or mean 1.7–3.6 cm). Anastomotic bursting pressures and specimen quality were poorly documented.

Conclusions

The technique of EFTR is developing, but the inability to close the resection defect reliably is a major obstacle. The review highlights the challenges that need to be addressed in future preclinical studies.

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Acknowledgment

The authors thank Mr. Aaron Southgate who produced the figures for this article.

Disclosures

N. R. A. Symons, O. Faiz, C. Fraser, S. K. Clark, and R. H. Kennedy have no conflict of interests. Adela Brigic is funded by Ethicon EndoSurgery.

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Authors and Affiliations

  1. Department of Surgery, St. Mark’s Hospital and Academic Institute, Watford Road, London, HA1 3UJ, UK

    Adela Brigic, Susan K. Clark & Robin H. Kennedy

  2. Academic Surgical Unit, Department of Surgery and Cancer, St. Mary’s Hospital, Imperial College London, 10th Floor, QEQM Building, South Wharf Road, London, W2 1NY, UK

    Nicholas R. A. Symons & Omar Faiz

  3. Wolfson Endoscopy Unit, St. Mark’s Hospital and Academic Institute, Watford Road, London, HA1 3UJ, UK

    Chris Fraser

Authors
  1. Adela Brigic
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  2. Nicholas R. A. Symons
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  3. Omar Faiz
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  4. Chris Fraser
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  5. Susan K. Clark
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  6. Robin H. Kennedy
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Correspondence to Robin H. Kennedy.

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Brigic, A., Symons, N.R.A., Faiz, O. et al. A systematic review regarding the feasibility and safety of endoscopic full thickness resection (EFTR) for colonic lesions. Surg Endosc 27, 3520–3529 (2013). https://doi.org/10.1007/s00464-013-2946-z

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  • DOI: https://doi.org/10.1007/s00464-013-2946-z

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