Adverse Events of Endoscopic Full-Thickness Resection: Results From the German and Dutch Colorectal FTRD Registry

Zwager, Liselotte W.; Mueller, J.; Stritzke, Bettina; Montazeri, Nahid S.; Caca, Karel; Dekker, Evelien; Fockens, Paul; Schmidt, Arthur; Bastiaansen, Barbara A.

doi:10.1016/j.gie.2022.04.707

Cited by 8 publications

(9 citation statements)

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“…Recently, a large international study collected data on adverse events after eFTR from both German and Dutch colorectal FTRD registries [37]. The results confirmed the safety of the procedure with an overall AE rate of 11.3%, of which 3.4% moderate-severe bleeding and 2.5% perforation [37]. In our eFTR study, the absence of adverse events is likely attributed to the limited sample size and the retrospective nature of the design.…”

Section: Discussionsupporting

confidence: 65%

“…Also, Zwager et al showed a low rate of complications, with 9.3% of adverse events, of which only 2.7% were classified as severe. Recently, a large international study collected data on adverse events after eFTR from both German and Dutch colorectal FTRD registries [37]. The results confirmed the safety of the procedure with an overall AE rate of 11.3%, of which 3.4% moderate-severe bleeding and 2.5% perforation [37].…”

Section: Discussionmentioning

confidence: 88%

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Endoscopic full-thickness resection vs. endoscopic submucosal dissection of residual/recurrent colonic lesions on scars: a retrospective Italian and Japanese comparative study

Barbaro,

Papparella,

Chiappetta

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Background and aims Endoscopic treatment of recurrent/residual colonic lesions on scars is a challenging procedure. In this setting, endoscopic submucosal dissection (ESD) is considered the first choice, despite a significant rate of complications. Endoscopic full-thickness resection (eFTR) has been shown to be well-tolerated and effective for these lesions. The aim of this study is to conduct a comparison of outcomes for resection of such lesions between ESD and eFTR in an Italian and a Japanese referral center. Methods From January 2018 to July 2020, we retrospectively enrolled patients with residual/recurrent colonic lesions, 20 treated by eFTR in Italy and 43 treated by ESD in Japan. The primary outcome was to compare the two techniques in terms of en-bloc and R0-resection rates, whereas complications, time of procedure, and outcomes at 3-month follow-up were evaluated as secondary outcomes. Results R0 resection rate was not significantly different between the two groups [18/20 (90%) and 41/43 (95%); P= 0.66]. En-bloc resection was 100% in both groups. No significant difference was found in the procedure time (54 min vs. 61 min; P= 0.9). There was a higher perforation rate in the ESD group [11/43 (26%) vs. 0/20 (0%); P= 0.01]. At the 3-month follow-up, two lesions relapsed in the eFTR cohort and none in the ESD cohort (P= 0.1). Conclusion eFTR is a safer, as effective and equally time-consuming technique compared with ESD for the treatment of residual/recurrent colonic lesions on scars and could become an alternative therapeutic option for such lesions.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 88%

Endoscopic full-thickness resection vs. endoscopic submucosal dissection of residual/recurrent colonic lesions on scars: a retrospective Italian and Japanese comparative study

Barbaro,

Papparella,

Chiappetta

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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“…Serious adverse events were not observed. In contrast, the national German and Dutch registry of eFTR procedures reports an overall complication rate of 11.3%, of which 2.2% were serious adverse events requiring emergency surgery, mostly because of delayed or immediate perforation or secondary appendicitis [29]. ESD is also associated with an overall risk of immediate perforation that varies from 3.8% in Asian countries up to 6.6% in Western countries because of the thin colonic wall [30, 31].…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic‐assisted laparoscopic wedge resection versus segmental colon resection for benign colonic polyps: a comparative cost analysis

Hanevelt,

Leicher,

Moons

et al. 2023

Colorectal Disease

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AimThe colonoscopic‐assisted laparoscopic wedge resection (CAL‐WR) is proven to be an effective and safe alternative to a segmental colon resection (SCR) for large or complex benign colonic polyps that are not eligible for endoscopic removal. This analysis aimed to evaluate the costs of CAL‐WR and compare them to the costs of an SCR.MethodA single‐centre 90‐day ‘in‐hospital’ comparative cost analysis was performed on patients undergoing CAL‐WR or SCR for complex benign polyps between 2016 and 2020. The CAL‐WR group consisted of 44 patients who participated in a prospective multicentre study (LIMERIC study). Inclusion criteria were (1) endoscopically unresectable benign polyps; (2) residual or recurrence after previous polypectomy; or (3) irradically resected low risk pT1 colon carcinoma. The comparison group, which was retrospectively identified, included 32 patients who underwent an elective SCR in the same period.ResultsColonoscopic‐assisted laparoscopic wedge resection was associated with significantly fewer complications (7% in the CAL‐WR group vs. 45% in the SCR group, P < 0.001), shorter operation time (50 min in the CAL‐WR group vs. 119 min in the SCR group, P < 0.001), shorter length of hospital stay (median length of stay 2 days in the CAL‐WR group vs. 4 days in the SCR group, P < 0.001) and less use of surgical resources (reduction in costs of 32% per patient), resulting in a cost savings of €2372 (£2099 GBP) per patient (P < 0.001).ConclusionGiven the clinical and financial benefits, CAL‐WR should be recommended for complex benign polyps that are not eligible for endoscopic resection before major surgery is considered.

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“…Alternatively, for en bloc resection of nonlifting lesions ≤2 cm, endoscopic full-thickness resection (EFTR) has shown good efficacy, but the risk of delayed perforation and need for surgery are 2.5 % and 2.2 %, respectively, which is well above the rates seen with other techniques, where the need for surgery for AEs is rare [121][122][123][124]. For en bloc resection of larger nonlifting lesions, ESD may be an option in expert centers, but it is (much) more challenging than ESD for lesions with good lifting [125,126].…”

Section: Recommendationmentioning

confidence: 99%

Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2024

Ferlitsch,

Hassan,

Bisschops

et al. 2024

Endoscopy

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Main Recommendations 1 ESGE recommends cold snare polypectomy (CSP), to include a clear margin of normal tissue (1–2 mm) surrounding the polyp, for the removal of diminutive polyps (≤ 5 mm).Strong recommendation, high quality of evidence. 2 ESGE recommends against the use of cold biopsy forceps excision because of its high rate of incomplete resection.Strong recommendation, moderate quality of evidence. 3 ESGE recommends CSP, to include a clear margin of normal tissue (1–2 mm) surrounding the polyp, for the removal of small polyps (6–9 mm).Strong recommendation, high quality of evidence. 4 ESGE recommends hot snare polypectomy for the removal of nonpedunculated adenomatous polyps of 10–19 mm in size.Strong recommendation, high quality of evidence. 5 ESGE recommends conventional (diathermy-based) endoscopic mucosal resection (EMR) for large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs).Strong recommendation, high quality of evidence. 6 ESGE suggests that underwater EMR can be considered an alternative to conventional hot EMR for the treatment of adenomatous LNPCPs.Weak recommendation, moderate quality of evidence. 7 Endoscopic submucosal dissection (ESD) may also be suggested as an alternative for removal of LNPCPs of ≥ 20 mm in selected cases and in high-volume centers.Weak recommendation, low quality evidence. 8 ESGE recommends that, after piecemeal EMR of LNPCPs by hot snare, the resection margins should be treated by thermal ablation using snare-tip soft coagulation to prevent adenoma recurrence.Strong recommendation, high quality of evidence. 9 ESGE recommends (piecemeal) cold snare polypectomy or cold EMR for SSLs of all sizes without suspected dysplasia.Strong recommendation, moderate quality of evidence. 10 ESGE recommends prophylactic endoscopic clip closure of the mucosal defect after EMR of LNPCPs in the right colon to reduce to reduce the risk of delayed bleeding.Strong recommendation, high quality of evidence. 11 ESGE recommends that en bloc resection techniques, such as en bloc EMR, ESD, endoscopic intermuscular dissection, endoscopic full-thickness resection, or surgery should be the techniques of choice in cases with suspected superficial invasive carcinoma, which otherwise cannot be removed en bloc by standard polypectomy or EMR.Strong recommendation, moderate quality of evidence.

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Adverse Events of Endoscopic Full-Thickness Resection: Results From the German and Dutch Colorectal FTRD Registry

Cited by 8 publications

References 0 publications

Endoscopic full-thickness resection vs. endoscopic submucosal dissection of residual/recurrent colonic lesions on scars: a retrospective Italian and Japanese comparative study

Endoscopic full-thickness resection vs. endoscopic submucosal dissection of residual/recurrent colonic lesions on scars: a retrospective Italian and Japanese comparative study

Colonoscopic‐assisted laparoscopic wedge resection versus segmental colon resection for benign colonic polyps: a comparative cost analysis

Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2024

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