scholarly journals Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a prospective observational case study

2018 ◽  
Vol 06 (09) ◽  
pp. E1112-E1119 ◽  
Author(s):  
Maxime E.S. Bronzwaer ◽  
Barbara A.J. Bastiaansen ◽  
Lianne Koens ◽  
Evelien Dekker ◽  
Paul Fockens
Keyword(s):  
Colorectal Polyps ◽  
Exclusion Criterion ◽  
R0 Resection ◽  
Full Thickness ◽  
Technical Success ◽  
En Bloc ◽  
Invasive Approach ◽  
Tertiary Referral Center ◽  
Endoscopic Full Thickness Resection

Abstract Background and study aims Colorectal polyps involving the appendiceal orifice (AO) are difficult to resect with conventional polypectomy techniques and therefore often require surgical intervention. These appendiceal polyps could potentially be removed with endoscopic full-thickness resection (eFTR) performed with a full-thickness resection device (FTRD). The aim of this prospective observational case study was to evaluate feasibility, technical success and safety of eFTR procedures involving the AO. Patients and methods This study was performed between November 2016 and December 2017 in a tertiary referral center by two experienced endoscopists. All patients referred for eFTR with a polyp involving the AO that could not be resected by EMR due to more than 50 % circumferential involvement of the AO or deep extension into the AO were included. The only exclusion criterion was lesion diameter > 20 mm. Results Seven patients underwent eFTR for a polyp involving the AO. All target lesions could be reached with the FTRD and retracted into the device. Technical success with an endoscopic radical en-bloc and full-thickness resection was achieved in all cases. Histopathological R0 resection was achieved in 85.7 % of patients (6/7). One patient who previously underwent an appendectomy developed a small abscess adjacent to the resection site, which was treated conservatively. Another patient developed secondary appendicitis followed by a laparoscopic appendectomy. Conclusion This small exploratory study suggests that eFTR of appendiceal polyps is feasible and can offer a minimally invasive approach for radical resection of these lesions. However, more safety and long-term follow-up data are needed to evaluate this evolving technique.

scholarly journals Endoscopic full-thickness resection with an over-the-scope clip device (FTRD) in the colorectum: results from a university tertiary referral center

2018 ◽  
Vol 06 (01) ◽  
pp. E98-E103 ◽  
Author(s):  
Francesco Vitali ◽  
Andreas Naegel ◽  
Juergen Siebler ◽  
Markus Neurath ◽  
Timo Rath
Keyword(s):  
Intraepithelial Neoplasia ◽  
R0 Resection ◽  
Low Grade ◽  
Full Thickness ◽  
Technical Success ◽  
Recurrence Rates ◽  
Invasive Approach ◽  
Tertiary Referral Center ◽  
Endoscopic Techniques ◽  
Over The Scope Clip

Abstract Background and study aims The full-thickness resection device (FTRD) represents a novel endoscopic treatment method for lesions unresectable with conventional endoscopic techniques. The overall aim of this study was to evaluate technical success and in toto resection rates, recurrence rates, as well as immediate or late complications in patients who underwent polyp removal with the FTRD. Patients and methods Data from a prospectively collected database of 12 patients who underwent 13 over-the-scope clip-based full-thickness resections between June 2015 and June 2017 were analyzed. Follow-up endoscopy was performed in 11 out of 12 patients. Results 13 full-thickness resections were performed in 7 males and 5 females (mean age 64.3 ± 6.3 years). Mean size of the lesions removed with FTRD was 17 ± 4 mm. Location was rectum (n = 6), cecum (n = 2), ascending colon (n = 2), left flexure (n = 1) and right flexure (n = 2). Mean procedure time was 68 ± 35 minutes and mean hospital stay was 2.5 ± 1.2 days. 2 patients developed post-polypectomy syndrome, which resolved after conservative treatment. No perforations and no immediate surgical revision were needed. Histology of the 13 lesions removed with FTRD showed 5 adenomas with low grade intraepithelial neoplasia (IEN), 4 high grade IEN, 1 fibrosis, 1 fibrosis without dysplasia and 2 adenocarcinomas. Technical success was achieved in all procedures (13/13, 100 %). R0 resection was achieved in 10/12 patients (83.3 %). 2 patients underwent surgery because of recurrence or not evaluable margins. In 1 patient no residual malignancy was proven in histological examination, in the other patient residual low grade IEN adenoma. Conclusion FTRD is a minimally invasive approach with good success rate of complete resection and minimal side effects.

scholarly journals Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

Endoscopy ◽  
2020 ◽  
Vol 52 (11) ◽  
pp. 1014-1023 ◽  
Author(s):  
Liselotte W. Zwager ◽  
Barbara A. J. Bastiaansen ◽  
Maxime E. S. Bronzwaer ◽  
Bas W. van der Spek ◽  
G. Dimitri N. Heine ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Adverse Event Rate ◽  
Resection Margins ◽  
R0 Resection ◽  
Incomplete Resection ◽  
Full Thickness ◽  
Technical Success ◽  
En Bloc ◽  
Endoscopic Full Thickness Resection

Abstract Background Endoscopic full-thickness resection (eFTR) is a minimally invasive resection technique that allows definite diagnosis and treatment for complex colorectal lesions ≤ 30 mm unsuitable for conventional endoscopic resection. This study reports clinical outcomes from the Dutch colorectal eFTR registry. Methods Consecutive patients undergoing eFTR in 20 hospitals were prospectively included. The primary outcome was technical success, defined as macroscopic complete en bloc resection. Secondary outcomes were: clinical success, defined as tumor-free resection margins (R0 resection); full-thickness resection rate; and adverse events. Results Between July 2015 and October 2018, 367 procedures were included. Indications were difficult polyps (non-lifting sign and/or difficult location; n = 133), primary resection of suspected T1 colorectal cancer (CRC; n = 71), re-resection after incomplete resection of T1 CRC (n = 150), and subepithelial tumors (n = 13). Technical success was achieved in 308 procedures (83.9 %). In 21 procedures (5.7 %), eFTR was not performed because the lesion could not be reached or retracted into the cap. In the remaining 346 procedures, R0 resection was achieved in 285 (82.4 %) and full-thickness resection in 288 (83.2 %). The median diameter of resected specimens was 23 mm. Overall adverse event rate was 9.3 % (n = 34/367): 10 patients (2.7 %) required emergency surgery for five delayed and two immediate perforations and three cases of appendicitis. Conclusion eFTR is an effective and relatively safe en bloc resection technique for complex colorectal lesions with the potential to avoid surgery. Further studies assessing the role of eFTR in early CRC treatment with long-term outcomes are needed.

scholarly journals Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors - a retrospective analysis

2020 ◽  
Author(s):  
Markus Brand ◽  
Stanislaus Reimer ◽  
Joachim Reibetanz ◽  
Sven Flemming ◽  
Marko Kornmann ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Transanal Endoscopic Microsurgery ◽  
Local Treatment ◽  
University Hospital ◽  
R0 Resection ◽  
Full Thickness ◽  
Resection Rate ◽  
En Bloc ◽  
Endoscopic Full Thickness Resection ◽  
Endoscopic Microsurgery

Abstract Purpose Local treatment of small well-differentiated rectal neuroendocrine tumors (NETs) is recommended by current guidelines. However, although several endoscopic methods have been established, the highest R0 rate is achieved by transanal endoscopic microsurgery (TEM). Since a recently published study about endoscopic full thickness resection (eFTR) showed a R0 resection rate of 100%, the aim of this study was to evaluate both methods (eFTR vs. TEM). Methods We retrospectively analyzed all patients with rectal NET treated either by TEM (1999–2018) or eFTR (2016–2019) in two tertiary centers (University Hospital Wuerzburg and Ulm). We analyzed clinical, procedural, and histopathological outcomes in both groups. Results Twenty-eight patients with rectal NET received local treatment (TEM: 13; eFTR: 15). Most tumors were at stage T1a and grade G1 or G2 (in the TEM group two G3 NETs were staged T2 after neoadjuvant chemotherapy). In both groups, similar outcomes for en bloc resection rate, R0 resection rate, tumor size, or specimen size were found. No procedural adverse events were noted. Mean procedure time in the TEM group was 48.9 min and 19.2 min in the eFTR group. Conclusion eFTR is a convincing method for local treatment of small rectal NETs combining high safety and efficacy with short interventional time.

scholarly journals Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety

2018 ◽  
Vol 06 (10) ◽  
pp. E1227-E1234 ◽  
Author(s):  
Krijn Haasnoot ◽  
Bas van der Spek ◽  
Christof Meischl ◽  
Dimitri Heine
Keyword(s):  
Colorectal Carcinoma ◽  
Adverse Events ◽  
R0 Resection ◽  
Radical Excision ◽  
Full Thickness ◽  
Efficacy And Safety ◽  
Technical Success ◽  
Endoscopic Techniques ◽  
T1 Colorectal Carcinoma ◽  
Endoscopic Full Thickness Resection

Abstract Background and study aims Endoscopic full-thickness resection (eFTR) allows en-bloc and transmural resection of colorectal lesions for which other advanced endoscopic techniques are unsuitable. We present our experience with a novel “clip first, cut later” eFTR-device and evaluate its indications, efficacy and safety. Patients and methods From July 2015 through October 2017, 51 eFTR-procedures were performed in 48 patients. Technical success and R0-resection rates were prospectively recorded and retrospectively analyzed. Results Indications for eFTR were non-lifting adenoma (n = 19), primary resection of malignant lesion (n = 2), resection of scar tissue after incomplete endoscopic resection of low-risk T1 colorectal carcinoma (n = 26), adenoma involving a diverticulum (n = 2) and neuroendocrine tumor (n = 2). Two lesions were treated by combining endoscopic mucosal resection and eFTR. Technical success was achieved in 45 of 51 procedures (88 %). Histopathology confirmed full-thickness resection in 43 of 50 specimens (86 %) and radical resection (R0) in 40 procedures (80 %). eFTR-specimens, obtained for indeterminate previous T1 colorectal carcinoma resection, were free of residual carcinoma in 25 of 26 cases (96 %). In six patients (13 %) a total of eight adverse events occurred within 30 days after eFTR. One perforation occurred, which was corrected endoscopically. No emergency surgery was necessary. Conclusion In this study eFTR appears to be safe and effective for the resection of colorectal lesions. Technical success, R0-resection and major adverse events rate were reasonable and comparable with eFTR data reported elsewhere. Mean specimen diameter (23 mm) limits its use to relatively small lesions. A clinical algorithm for eFTR case selection is proposed. eFTR ensured local radical excision where other endoscopic techniques did not suffice and reduced the need for surgery in selected cases.

scholarly journals Endoscopic full thickness resection (EFTR) of colorectal neoplasms with the Full Thickness Resection Device (FTRD): Clinical experience from two tertiary referral centers in Switzerland

2017 ◽  
Vol 6 (3) ◽  
pp. 463-470 ◽  
Author(s):  
Patrick Aepli ◽  
Dominique Criblez ◽  
Stephan Baumeler ◽  
Jan Borovicka ◽  
Remus Frei
Keyword(s):  
Clinical Experience ◽  
Prospective Studies ◽  
Colonic Polyps ◽  
Benign Neoplasms ◽  
Full Thickness ◽  
Technical Success ◽  
Tertiary Referral ◽  
En Bloc ◽  
Post Procedure ◽  
Endoscopic Full Thickness Resection

Background Endoscopic full thickness resection (EFTR) by the Full Thickness Resection Device (FTRD) has recently been introduced as a method to allow resection of certain lesions such as adenomatous polyps that would not be resectable by standard polypectomy techniques. We report our clinical experience with FTRD procedures, assessing technical success, completeness of resection (R0 status), rate of histologically proven FTR and safety. Patients and methods We conducted a retrospective analysis of 33 consecutive patients with colonic polyps treated with FTRD from May 2015 to November 2016. Results Indications mainly were adenoma recurrence or residual adenoma with nonlifting sign after previous polypectomy. In the 31 cases amenable to EFTR, resection was en bloc and histologically complete (R0) in 87.9% (29/33) of patients. Histologically confirmed complete full thickness resection (FTR) was achieved in 80.6% (25/31). Three post-procedure bleedings and one perforation were seen. Conclusion FTRD offers an additional endoscopic approach to treat nonlifting colorectal lesions. EFTR by FTRD appears to be feasible and efficacious in the resection of benign neoplasms of up to 30 mm in diameter and may be an alternative to surgery in selected patients. Given a significant rate of complications, safety is a concern and needs to be assessed in larger prospective studies.

scholarly journals Endoscopic full-thickness resection versus endoscopic submucosal dissection in the treatment of colonic neoplastic lesions ≤ 30 mm—a single-center experience

2021 ◽  
Author(s):  
Přemysl Falt ◽  
Jana Zapletalová ◽  
Ondřej Urban
Keyword(s):  
Success Rate ◽  
Curative Resection ◽  
R0 Resection ◽  
Full Thickness ◽  
Procedure Time ◽  
Technical Success ◽  
Resection Rate ◽  
Technical Success Rate ◽  
Neoplastic Lesions ◽  
Endoscopic Full Thickness Resection

AbstractEndoscopic full-thickness resection (FTR) is a novel technique of endoscopic treatment of colorectal neoplastic lesions not suitable for endoscopic polypectomy or mucosal resection. FTR appears to be a reasonable alternative to technically demanding endoscopic submucosal dissection (ESD) for lesions ≤ 30 mm. However, comparison between FTR and ESD has not been published yet and their mutual positioning in the treatment algorithm is still unclear. The purpose of the analysis was to evaluate efficacy and safety of FTR in the treatment of colorectal lesions ≤ 30 mm by comparing prospectively followed FTR cohort to retrospective ESD cohort in the setting of single tertiary endoscopy center. Primary outcomes were technical success rate, R0 resection and curative resection rate, and complication rate. A total of 52 patients in FTR and 50 patients in ESD group were treated between 2015 and 2018. Technical success rate was significantly higher in FTR group (92 vs. 74%, P = 0.01) as well as R0 resection rate (85 vs. 62%, P = 0.01) and curative resection rate (75 vs. 56%, P = 0.01). Complications occurred more frequently in ESD group (40 vs. 13%, P = 0.002), mainly due to high incidence of electrocoagulation syndrome (24 vs. 0%). Total procedure time was substantially shorter in FTR group (26.4 ± 11.0 min vs. estimated 90–240 min). Local residual neoplastic lesions were detected numerically more often in FTR group (12 vs. 5%, P = 0.12). No patient died during follow-up. Compared to ESD, FTR proved significantly higher technical success rate, higher R0 and curative resection rate, and shorter procedure time. In the FTR group, there were significantly less complications but higher incidence of local residual neoplasia. Further research including randomized trials is needed to compare both resection techniques.

Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry

Endoscopy ◽  
2021 ◽  
Author(s):  
Liselotte W. Zwager ◽  
Barbara Bastiaansen ◽  
Bas van der Spek ◽  
Dimitri Heine ◽  
Ramon Michel Schreuder ◽  
...  
Keyword(s):  
Curative Resection ◽  
Histological Evaluation ◽  
R0 Resection ◽  
Incomplete Resection ◽  
Full Thickness ◽  
Technical Success ◽  
Short Term ◽  
Residual Cancer ◽  
Oncologic Surgery ◽  
Endoscopic Full Thickness Resection

Background and study aims: Complete endoscopic resection and accurate histological evaluation for T1 colorectal cancer (CRC) is critical to determine subsequent treatment. Endoscopic Full-Thickness Resection (eFTR) is a new treatment option for T1 CRC <2cm. We aim to report clinical outcomes and short-term results. Patients and methods: Consecutive eFTR procedures for T1 CRC, prospectively recorded in our national registry between November 2015 and April 2020, were retrospectively analysed. Primary outcomes were technical success and R0 resection. Secondary outcomes were histological risk-assessment, curative resections, adverse events and short-term outcomes. Results: We included 330 procedures: 132 primary resections and 198 secondary scar resections after incomplete T1 CRC resection. Overall technical success, R0 resection and curative resection rates were 87.0% (95% CI [82.7 – 90.3%]), 85.6% (95% CI [81.2 – 89.2%]) and 60.3% (95% CI [54.7 – 65.7%]). Curative resection rate for primary resected T1 CRC was 23.7% (95% CI [15.9 – 33.6%]) and 60.8% (95% CI [50.4 – 70.4%]) after excluding deep submucosal invasion as risk-factor. Risk-stratification was possible in 99.3%. Severe adverse event rates was 2.2%. Additional oncologic surgery was performed in 49/320 (15.3%), with residual cancer in 11/49 (22.4%). Endoscopic follow-up was available in 200/242 (82.6%), with a median of 4 months and residual cancer in 1 (0.5%) following an incomplete resection. Conclusions: eFTR is a relatively safe and effective method to resect small T1 CRC, both as primary and secondary treatment. eFTR can expand endoscopic treatment options for T1 CRC and could help to reduce surgical overtreatment. Future studies should focus on long-term outcomes.

Endoscopic Full-Thickness Resection of Polyps Involving the Appendiceal Orifice: A Multicenter International Experience

Endoscopy ◽  
2021 ◽  
Author(s):  
Yervant Ichkhanian ◽  
Mohammed Barawi ◽  
Shyam J Thakkar ◽  
Talal Seoud ◽  
Truptesh H Kothari ◽  
...  
Keyword(s):  
Clinical Success ◽  
Tertiary Care ◽  
En Bloc Resection ◽  
Prior History ◽  
R0 Resection ◽  
Full Thickness ◽  
Technical Success ◽  
En Bloc ◽  
Surgical Interventions ◽  
Neoplastic Lesions

Background and Aims: Endoscopic resection of lesions involving the appendiceal orifice (AO) remains a challenge. We aim to report the outcomes of full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. Methods: This is a retrospective study at 18 tertiary-care centers (12 U.S., Canada 1, 5 Europe) between 11/2016 and 8/2020. Consecutive patients who underwent resection of AO lesions using the FTRD were included. The primary outcome was the rate of R0 margin resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of; technical success (en bloc resection), clinical success (technical success without need for further surgical interventions), post-resection appendicitis, and polyp recurrence. Results: A total of 66 patients (mean age 64 yr., 29 F) underwent resection of colonic lesions (mean size 14.5 (6.2) mm) involving the AO, with 40 (61%) deep extending into the appendiceal lumen. Technical success was achieved in 59/66 (89%) cases, out of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80%). R0 resection was achieved in 52/56 (93%) cases. Out of the 58 patients of whom EFTR was completed and had no prior history of appendectomy, appendicitis was reported in 10 (17%) cases, with 6 (60%) requiring surgical appendectomies. Follow-up colonoscopy was completed in 41 cases with evidence of recurrence in 5 (12.2%). Conclusions: FTRD is a promising non-surgical alternative for resecting appendiceal lesions but appendicitis occurs in 1 out of 6 cases.

scholarly journals Feasibility and safety of third-space endoscopic full-thickness resection in ex vivo and in vivo porcine models

2019 ◽  
Vol 07 (04) ◽  
pp. E471-E476 ◽  
Author(s):  
Osamu Goto ◽  
Motoki Sasaki ◽  
Teppei Akimoto ◽  
Atsushi Tatsuguchi ◽  
Mitsuru Kaise ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Third Space ◽  
R0 Resection ◽  
Full Thickness ◽  
Entry Site ◽  
Submucosal Tunnel ◽  
Endoscopic Full Thickness Resection ◽  
Mucosal Incision ◽  
Technical Issues

Abstract Background and study aims Endoscopic full-thickness resection (EFTR) involves several technical issues that need to be addressed. We devised a novel technique termed third-space EFTR and investigated its feasibility and safety in animal models. Methods Third-space EFTR was performed in three isolated porcine stomachs (ex vivo) and four live pigs (in vivo, 1-week survival). The technique involved a circumferential mucosal incision, submucosal tunnelling on the proximal side, endoscopic suturing of the surrounding mucosa, a circumferential seromuscular incision in the submucosal tunnel, transoral retrieval and entry site closure of the tunnel. The technical outcomes were investigated. Results In the ex vivo study, the procedure was successfully completed with R0 resection. In the in vivo study, the procedure was completed in all pigs; however, R0 resection failed in one pig owing to snaring resection. All pigs survived without severe adverse events. Conclusions Our findings indicate that third-space EFTR is feasible and safe. This technique may be useful as a minimally invasive endoscopic option for reliable treatment of small gastric submucosal tumours.

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