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Endoscopic full-thickness resection (eFTR) in colon and rectum: indications and outcomes in the first 37 cases in a single center

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Abstract

Background

Segmental resection of the colon or rectum for cancer is major surgery with substantial procedure-related morbidity and mortality. A steep increase in the frequency of early cancer and advanced adenoma detection has been evident these late years. Introducing more minimal invasive resection techniques may decrease procedure-related complications and mortality. We aimed to describe the results from introducing endoscopic full-thickness resection (eFTR) in a unit specialized in advanced endoscopic resection of colon neoplasias. Primary outcomes were R0 resection rate and complications.

Methods

endoscopic full-thickness resection was introduced in our unit in 2017. Patients were referred for eFTR based on indications: (i) completion of resection after unexpected cancer, (ii) suspicion of or clinically confirmed early cancer (T1) without signs of dissemination, or (iii) adenomas not suitable for other endoscopic resection techniques due to difficult position or recurrence. Data on eFTR procedures and follow-up were retrieved from patient journals.

Results

Thirty-seven eFTR procedures were commenced in the period of March 2017 until June 2020, and one of these was abandoned. The overall R0 resection rate was 83.3%. In subgroups of indications i–iii, it was 87.5, 80.0, and 80.0%, respectively. Three perforations and one case of late bleeding occurred. One patient died within 30 days due to late perforation. Six technical failures were evident including operator-induced failures. Five of the technical failures occurred in the first half of the procedures indicating the learning curve of the endoscopist.

Conclusion

Implementation of the eFTR procedure has been largely successful, especially in patients referred for completion of resection after unexpected cancer. Complication rates were acceptable, and the technique and quality increased significantly during the study. Careful selection of patients for eFTR is crucial for achieving successful resection. Size and position of lesion seem more important than indication. eFTR is not effective for lesions > 30 mm.

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References

  1. Danish Colorectal Cancer Group (DCCG) (2020) National årsrapport 2019 [National Annual report 2019]

  2. Brenner H, Stock C, Hoffmeister M (2014) Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ 348:g2467

    Article  PubMed  PubMed Central  Google Scholar 

  3. Freeman HJ (2013) Early stage colon cancer. World J Gastroenterol 19(46):8468–8473

    Article  PubMed  PubMed Central  Google Scholar 

  4. Meier B, Stritzke B, Kuellmer A, Zervoulakos P, Huebner GH, Repp M et al (2020) Efficacy and safety of endoscopic full-thickness resection in the colorectum: results from the german colonic FTRD registry. Am J Gastroenterol 115(12):1998–2006

    Article  PubMed  Google Scholar 

  5. Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag HJ, Messmann H et al (2018) Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 67(7):1280–1289

    Article  PubMed  Google Scholar 

  6. Aepli P, Criblez D, Baumeler S, Borovicka J, Frei R (2018) 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 Eur Gastroenterol J 6(3):463–470

    Article  Google Scholar 

  7. Kuellmer A, Mueller J, Caca K, Aepli P, Albers D, Schumacher B et al (2019) Endoscopic full-thickness resection for early colorectal cancer. Gastrointest Endosc 89(6):1180–9.e1

    Article  PubMed  Google Scholar 

  8. Boger P, Rahman I, Hu M, Ayaru L, Bhandari P, Chedgy F et al (2021) Endoscopic full thickness resection in the colo-rectum: outcomes from the UK Registry. Eur J Gastroenterol Hepatol 33(6):852–858

    Article  CAS  PubMed  Google Scholar 

  9. van der Spek B, Haasnoot K, Meischl C, Heine D (2018) Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety. Endosc Int Open 6(10):E1227–E1234

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ichkhanian Y, Vosoughi K, Diehl DL, Grimm IS, James TW, Templeton AW et al (2021) A large multicenter cohort on the use of full-thickness resection device for difficult colonic lesions. Surg Endosc 35(3):1296–1306

    Article  CAS  PubMed  Google Scholar 

  11. Velegraki M, Trikola A, Vasiliadis K, Fragaki M, Mpitouli A, Dimas I et al (2019) Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece. Ann Gastroenterol 32(5):482–488

    PubMed  PubMed Central  Google Scholar 

  12. Andrisani G, Soriani P, Manno M, Pizzicannella M, Pugliese F, Mutignani M et al (2019) Colo-rectal endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD((R))): a multicenter Italian experience. Dig Liver Dis 51(3):375–381

    Article  CAS  PubMed  Google Scholar 

  13. Zwager LW, Bastiaansen BAJ, Bronzwaer MES, van der Spek BW, Heine GDN, Haasnoot KJC et al (2020) Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry. Endoscopy 52(11):1014–1023

    Article  PubMed  Google Scholar 

  14. Fahmawi Y, Hanjar A, Ahmed Y, Abdalhadi H, Mulekar MS, Merritt L et al (2021) Efficacy and Safety of Full-thickness Resection Device (FTRD) for colorectal lesions endoscopic full-thickness resection: a systematic review and meta-analysis. J Clin Gastroenterol 55(4):e27–e36

    Article  PubMed  PubMed Central  Google Scholar 

  15. Li P, Ma B, Gong S, Zhang X, Li W (2021) Efficacy and safety of endoscopic full-thickness resection in the colon and rectum using an over-the-scope device: a meta-analysis. Surg Endosc 35(1):249–259

    Article  PubMed  Google Scholar 

  16. von Helden A, Hildenbrand R, Sido B, Dumoulin FL (2019) Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent/residual colorectal neoplasia: a single-center case series. BMC Gastroenterol 19(1):121

    Article  Google Scholar 

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Acknowledgements

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Funding

This work was not funded by any external source.

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Authors and Affiliations

  1. Department of Surgery, Odense University Hospital, Svendborg, Denmark

    Anders Høgh, Ulrik Deding, Thomas Bjørsum-Meyer, Niels Buch & Gunnar Baatrup

  2. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Ulrik Deding, Thomas Bjørsum-Meyer & Gunnar Baatrup

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  1. Anders Høgh
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  2. Ulrik Deding
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  3. Thomas Bjørsum-Meyer
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  4. Niels Buch
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  5. Gunnar Baatrup
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Correspondence to Anders Høgh.

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Dr. Anders Høgh, MSc Ulrik Deding, Dr. Thomas Bjørsum-Meyer, Dr. Niels Buch, and Professor Gunnar Baatrup have no conflicts of interest or financial ties to disclose.

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Høgh, A., Deding, U., Bjørsum-Meyer, T. et al. Endoscopic full-thickness resection (eFTR) in colon and rectum: indications and outcomes in the first 37 cases in a single center. Surg Endosc 36, 8195–8201 (2022). https://doi.org/10.1007/s00464-022-09263-1

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  • DOI: https://doi.org/10.1007/s00464-022-09263-1

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