Full-thickness resection of neuroendocrine tumors in the rectum

Abstract Background Rectal neuroendocrine tumors (NETs) are subepithelial tumors with potential for malignancy. Depending on tumor characteristics, endoscopic or surgical resection is recommended. However, the optimal endoscopic approach is not defined. This is the first larger study evaluating endoscopic full-thickness resection (EFTR) of rectal NETs. Methods For resection, the full-thickness resection device (FTRD) was used. A registry was created as part of post-market clinical follow-up. All cases of rectal NETs in the registry were analyzed retrospectively. Results 31 German centers entered data of 501 FTRD procedures and 40 cases of rectal NETs were identified. The median lesion size was 8 mm. All lesions could be resected using FTRD. The median procedure time was 18.5 minutes. Resection was macroscopically and histologically complete in all cases. Full-thickness resection was achieved in 95 %. No major adverse events occurred. Endoscopic follow-up showed no evidence of residual or recurrent tumor. Conclusion EFTR is safe and effective for resection of smaller rectal NETs. Prospective comparative trials are needed to define the role of EFTR of rectal NETs.

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Wirksamkeit und Sicherheit der endoskopischen Vollwandresektion (FTRD): Ergebnisse des Deutschen Kolon FTRD Registers

Karger Kompass Onkologie ◽

10.1159/000514509 ◽

2021 ◽

pp. 1-2

Author(s):

Kia Homayounfar

Keyword(s):

Lesion Size ◽

Single Step ◽

R0 Resection ◽

Full Thickness ◽

Efficacy And Safety ◽

Term Outcome ◽

Long Term Outcome ◽

Endoscopic Full Thickness Resection

Introduction: Endoscopic full-thickness resection (EFTR) is a powerful option for resection of colorectal lesions not amenable to conventional endoscopic resection. The full-thickness resection device (FTRD) allows clip-assisted EFTR with a single-step technique. We report on results of a large nationwide FTRD registry. Methods: The «German colonic FTRD registry» was created to further assess efficacy and safety of the FTRD System after approval in Europe. Data were analyzed retrospectively. Results: Sixty-five centers contributed 1,178 colorectal FTRD procedures. Indications for EFTR were difficult adenomas (67.1%), early carcinomas (18.4%), subepithelial tumors (6.8%), and diagnostic EFTR (1.3%). Mean lesion size was 15 × 15 mm and most lesions were pretreated endoscopically (54.1%). Technical success was 88.2% and R0 resection was achieved in 80.0%. R0 resection was significantly higher for subepithelial tumor compared with that for other lesions. No difference in R0 resection was found for smaller vs larger lesions or for colonic vs rectal procedures. Adverse events occurred in 12.1% (3.1% major events and 2.0% required surgical treatment). Endoscopic follow-up was available in 58.0% and showed residual/recurrent lesions in 13.5%, which could be managed endoscopically in most cases (77.2%). Discussion: To date, this is the largest study of colorectal EFTR using the FTRD System. The study demonstrated favorable efficacy and safety for «difficult-to-resect» colorectal lesions and confirms results of previous studies in a large «real-world» setting. Further studies are needed to compare EFTR with other advanced resection techniques and evaluate long-term outcome.

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

International Journal of Colorectal Disease ◽

10.1007/s00384-020-03800-x ◽

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.

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The role of bone marrow edema on autologous matrix induced chondrogenesis for the treatment of osteochondral lesions of the talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000151 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Riccardo D’Ambrosi ◽

Camilla Maccario ◽

Federico Giuseppe Usuelli

Keyword(s):

Bone Marrow ◽

Repeated Measures ◽

Bone Marrow Edema ◽

Lesion Size ◽

Osteochondral Lesions ◽

Significant Difference ◽

T1 And T2 ◽

Marrow Edema

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: to assess the functional and radiological outcomes after AT-AMIC® (arthroscopic talus autologous matrix induced chondrogenesis) in 2 groups: patients with and without bone marrow edema (BME). Methods: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for osteochondral talar lesion. MRI and CT-scan evaluations, as well as clinical evaluations measured by the VAS score for pain, AOFAS and SF-12 were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. Results: GNE consisted of 24 patients while GE consisted of 13 patients. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points(p<0.001). In GNE, AOFAS improved significantly at each follow-up(p<0.05); while CT and MRI showed a significant decrease between T1 and T2 and T2 and T3(p<0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3(p<0.05); CT decreased between T1 and T2(p<0.05), while MRI showed a reduction at each follow-up(p<0.05). Lesion size was significantly higher both in MRI and CT in GE in respect to GNE(p<0.05). In the GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. Conclusion: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.

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Resección endoscópica transmural del colon. Reporte de tres casos

Acta gastroenterológica latinoamericana ◽

10.52787/bclv6860 ◽

2020 ◽

Author(s):

Luis Ernesto Caro ◽

Sandra Canseco ◽

Christian Sánchez ◽

Pablo Hoffman ◽

María Carolina Bolino

Keyword(s):

Histopathological Examination ◽

Plain Film ◽

Complete Resection ◽

High Grade ◽

Defect Closure ◽

Full Thickness ◽

Tumor Delineation ◽

Small Series ◽

Endoscopic Full Thickness Resection

Introduction. Endoscopic Full-thickness Resection (EFTR) consists of the full-thickness resection of a limited portion of the digestive wall immediately followed by defect closure. This technique has been proposed for the resection of selected lesions not amenable to conventional endoscopic resection. Objective. The aim of this work is to describe the first three cases of colonic EFTR performed in Argentina. Material and methods. Three patients are described, one with a laterally spreading tumor of approximately 35-40 mm (n = 1) and two with an incomplete adenoma resection with a scar and a non-lifting sing (n = 2). After tumor delineation using a marking probe, EFTR was performed using the full thickness resection device (FTRD, Ovesco, Germany). Antibiotic prophylaxis was prescribed, abdominal plain film was performed 5 hours after the procedure and hospital discharge was granted after twenty four hours. Results. The resection of the lesions was macroscopically complete and no signs of perforation or significant bleeding were detected. Histopathological examination confirmed the complete resection of a tubulovillous (n = 2) and a tubular (n = 1) adenoma, all with high-grade dysplasia. No complications were detected during the follow up. Conclusion. It was concluded that the EFTR is an innovative technique that was effective and safe used in this small series of patients as an alternative to surgery.

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Endoscopic full-thickness resection of benign and malignant colon lesions with one-year follow up in a Danish cohort

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2021.2013526 ◽

2021 ◽

pp. 1-7

Author(s):

Mustafa Bulut ◽

Niels Buch ◽

Svend Knuhtsen ◽

Ismail Gögenur ◽

Lasse Bremholm

Keyword(s):

Full Thickness ◽

Endoscopic Full Thickness Resection ◽

Danish Cohort ◽

One Year

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Tu1920 The Role of Combination of Molecular Imaging Studies in the Follow-Up of Patients With Advanced Neuroendocrine Tumors

Gastroenterology ◽

10.1016/s0016-5085(15)33187-5 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-935

Author(s):

Christos Toumpanakis ◽

Vincent Cheung ◽

Roberta E. Rossi ◽

Shaunak Navalkissoor ◽

Ann-Marie Quigley ◽

...

Keyword(s):

Molecular Imaging ◽

Neuroendocrine Tumors ◽

Imaging Studies

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Long-term Clinical Outcomes of One-Stage Cartilage Repair in the Knee With Hyaluronic Acid–Based Scaffold Embedded With Mesenchymal Stem Cells Sourced From Bone Marrow Aspirate Concentrate

The American Journal of Sports Medicine ◽

10.1177/0363546519845362 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1621-1628 ◽

Cited By ~ 19

Author(s):

Alberto Gobbi ◽

Graeme P. Whyte

Keyword(s):

Clinical Outcomes ◽

Cartilage Repair ◽

Daily Living ◽

Bone Marrow Aspirate ◽

Lesion Size ◽

Cartilage Injury ◽

Full Thickness ◽

Outcome Scores

Background: Cell-based cartilage repair performed as a single-stage procedure is an important advancement in the treatment of full-thickness cartilage injury and has potential for widespread clinical use. Purpose: To investigate the long-term clinical outcomes of cartilage repair in the knee with a hyaluronic acid–based scaffold embedded with bone marrow aspirate concentrate (HA-BMAC) for the treatment of full-thickness cartilage injury. Study Design: Case series; Level of evidence, 4. Methods: Patients underwent treatment of full-thickness chondral injury in the knee with HA-BMAC and were followed prospectively for a minimum of 6 years. Clinical outcomes were examined with patient-reported scoring instruments that consisted of the Tegner Activity Scale, International Knee Documentation Committee (IKDC) subjective score, visual analog scale, and Knee injury and Osteoarthritis Outcome Score (KOOS). Comparative analysis of pre- and postoperative scores was performed, and the effects of patient age, body mass index, lesion size, number of treated lesions, and concurrent treatment with associated procedures were examined. Results: Twenty-three patients (mean age, 48.5 years) were followed prospectively for a mean 8 years (range, 6-10 years). Median cartilage lesion size was 6.5 cm2 (range, 2-27 cm2). At final follow-up, median Tegner, visual analog scale, and IKDC subjective scores were 4, 0.3, and 85, respectively. Final median KOOS subset scores were as follows: Pain, 94; Symptoms, 89; Activities of Daily Living, 99; Sports/Recreation, 85; and Quality of Life, 85. All scores were significantly increased at final follow-up ( P < .001). Comparable median outcome scores were demonstrated after categorization of patients by age, lesion size, treatment of multiple lesions, treatment of multiple knee compartments, and treatment by associated procedures. Rank correlation analysis demonstrated a negative correlation between patient age and final outcome scores of the IKDC, Tegner, and KOOS subsets of Pain, Activities of Daily Living, and Sports/Recreation. No associations were identified between body mass index or lesion size and outcome scores. Conclusion: Repair of full-thickness cartilage injury in the knee with a HA-BMAC provides good to excellent clinical outcomes at long-term follow-up in the treatment of small to large lesions. Cartilage repair with HA-BMAC leads to comparatively successful long-term outcomes in the treatment of small or large lesions, single or multiple lesions, and lesions in 1 or 2 compartments, as well as in cases of associated lesion treatment. While good outcomes can be expected among treated patients >45 years of age, outcomes may be comparatively more successful in younger patients.

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Ligation-assisted endoscopic full-thickness resection with over-the-scope clip targeted for neuroendocrine tumors

Annals of Gastroenterology ◽

10.20524/aog.2020.0468 ◽

2020 ◽

Author(s):

Hideki Kobara

Keyword(s):

Neuroendocrine Tumors ◽

Full Thickness ◽

Endoscopic Full Thickness Resection ◽

Over The Scope Clip

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Hybrid endoscopic mucosal resection and full-thickness resection for large colonic polyps harboring a small focus of invasive cancer: a case series

Endoscopy International Open ◽

10.1055/a-1529-1447 ◽

2021 ◽

Vol 09 (11) ◽

pp. E1686-E1691

Author(s):

Jamie S. Chua ◽

Hao Dang ◽

Liselotte W. Zwager ◽

Nik Dekkers ◽

James C. H. Hardwick ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Case Series ◽

Colonic Polyps ◽

Full Thickness ◽

Surveillance Colonoscopy ◽

Noninvasive Treatment ◽

Mucosal Resection ◽

Endoscopic Full Thickness Resection ◽

Small Focus

AbstractEndoscopic treatment of large laterally spreading tumors (LSTs) with a focus of submucosally invasive colorectal cancer (T1 CRC) can be challenging. We evaluated outcomes of a hybrid resection technique using piecemeal endoscopic mucosal resection (pEMR) and endoscopic full-thickness resection (eFTR) in patients with large colonic LSTs containing suspected T1 CRC. Six hybrid pEMR-eFTR procedures for T1 CRCs were registered in a nationwide eFTR registry between July 2015 and December 2019. In all cases, the invasive part of the lesion was successfully isolated with eFTR; with eFTR, histologically complete resection of the invasive part was achieved in 5 /6 patients (83.3 %). No adverse events occurred during or after the procedure. The median follow-up time was 10 months (range 6–27), with all patients having undergone ≥ 1 surveillance colonoscopy. One patient had a small adenomatous recurrence, which was removed endoscopically. In conclusion, hybrid pEMR-eFTR is a promising noninvasive treatment modality that seems feasible for a selected group of patients with large LSTs containing a small focus of T1 CRC.

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