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 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 (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.

Colorectal endoscopic full-thickness resection using a novel, flat-base over-the-scope clip: a prospective study

Endoscopy ◽  
2017 ◽  
Vol 49 (11) ◽  
pp. 1092-1097 ◽  
Author(s):  
Yara Backes ◽  
Wouter Kappelle ◽  
Luuk Berk ◽  
Arjun Koch ◽  
John Groen ◽  
...  
Keyword(s):  
Scar Tissue ◽  
Full Thickness ◽  
Technical Success ◽  
Malignant Polyp ◽  
Technical Success Rate ◽  
Flat Base ◽  
Endoscopic Full Thickness Resection ◽  
Over The Scope Clip ◽  
Technical Refinement ◽  
A Prospective Study

Abstract Background and study aims We aimed to evaluate the feasibility and safety of a new, flat-based over-the-scope clip (Padlock Clip) for colorectal endoscopic full-thickness resection (eFTR). Patients and methods We prospectively included 26 patients with lesions < 20 mm. Indications for eFTR were re-resection of the scar of a low risk malignant polyp (n = 11), recurrent adenoma in a non-lifting scar (n = 10), non-lifting polyp (n = 4), and an adenoma located in a diverticulum (n = 1). Results Technical success rate and full-thickness resection rate were 100 % (26/26) and 92 % (24/26), respectively. Median procedure time was 43 minutes (IQR 27 – 56). No complications occurred during the procedure; 3 complications (12 %) occurred within 48 hours, of which one was a perforation requiring laparoscopic suturing. Specimen volumes from eFTR of scar tissue where the original polyp had been ≥ 20 mm (n = 13) were smaller compared with those from non-scar resections or scars where the original polyps had been < 20 mm (n = 13) (median 0.8 vs. 1.5 cm3, P = 0.03). Conclusions In this first series of colorectal eFTR using the Padlock Clip, feasibility was demonstrated. It was relatively safe in view of surgery as the alternative treatment, but could still benefit from technical refinement. Future studies should explore for which indication this technique is most suitable.Trial registration: NTR5562 (Dutch Trial Register).

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.

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