Endoscopic full-thickness resection for early colorectal cancer

Kuellmer, Armin; Müeller, Jens-Dominik; Caca, Karel; Aepli, Patrick; Albers, David; Schumacher, Brigitte; Glitsch, Anne; Schäfer, Claus; Wallstabe, I.; Hofmann, Christopher; Erhardt, Andreas; Meier, Benjamin; Bettinger, Dominik; Thimme, Robert; Schmidt, Arthur

doi:10.1016/j.gie.2018.12.025

Cited by 108 publications

(108 citation statements)

References 24 publications

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“…In contrast, Schmidt et al did not recommend EFTR as a therapeutic approach for suspected or known carcinomas, because of the low rates of curative resection [5]. The most recent study of EFTR for early colorectal cancer by Kuellmer et al [30] compared R0 resection rate between incompletely resected malignant polyps and non-lifting malignant lesions without prior treatment. Overall, 34% of patients underwent surgical resection owing to "high-risk" histological features, whereas 62% were followed endoscopically.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece

Velegraki

Trikola

Vasiliadis

et al. 2019

aog

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Background Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD ) is an invasive treatment for colorectal lesions not resectable by conventional endoscopic techniques. This study presents the first Greek experience of the FTRD  procedure, assessing the efficacy and safety of EFTR. Methods We conducted a retrospective analysis of 17 consecutive patients treated with the FTRD  at 2 referral centers from October 2015 through December 2018. The indications included difficult adenomas (non-lifting and/or at difficult locations), early adenocarcinomas and subepithelial tumors. Primary endpoints were technical success and R0 resection. Results Technical success and R0 resection were achieved in 82.3% procedures (14/17) and in 87.5% of those with difficult adenomas (8 patients). In the subgroup with carcinomas (n=3), the rate of technical success and R0 resection was 66.6%, while in the subgroup with subepithelial tumors (n=6) the rate was 83.3%. Technical success and R0 resection were significantly lower for lesions >20 mm vs. ≤20 mm (P=0.0429). In the 17 patients a total of 3 adverse events occurred (17.6%) and one of the patients underwent laparoscopic appendectomy because of EFTR around the appendix. Conclusions Our study showed favorable results concerning EFTR feasibility, efficacy and safety, especially for lesions ≤20 mm, non-lifting adenomas, and subepithelial tumors. Technical success, R0 resection, and adverse events rates were comparable with previously published data. Larger randomized studies are needed to better define the clinical benefit and long-term outcomes of EFTR in selected patients.

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Section: Discussionmentioning

confidence: 99%

Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece

Velegraki

Trikola

Vasiliadis

et al. 2019

aog

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“…Main characteristics of the included studies are provided in ▶ Table 1 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Overall, 15 (83.3 %) studies were performed in Europe, two (11.1 %) being from the United States and one (5.5 %) from China.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis

et al. 2020

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Background and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and sub-epithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTRD or over-the-scope clip of gastrointestinal tumors. Methods A comprehensive literature search was performed. The primary outcome of interest was the rate of histologic complete resection (R0). Secondary outcomes of interest were the rate of enbloc resection, FTR, adverse events, and post-EFTR surgery. Random-effects model was used to calculate pooled estimates and generate forest plots. Results Eighteen studies with 730 patients and 733 lesions were included in the analyses. Indications for EFTR were difficult/residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice and early cancer (n = 634), colorectal SELs (n = 42), and upper gastrointestinal lesions (n = 51), other colonic lesions (n = 6). Median size of lesions was 13.5 mm. There were 22 failed EFTR attempts. Pooled overall R0 resection rate was 82 % (95 % CI: 75, 89). The pooled overall FTR rate was 83 % (95 % CI: 77, 89). The pooled overall enbloc resection rate was 95 (95 % CI: 92, 96). The pooled estimates for perforation and bleeding were < 0.1 % and 2 %, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason [pooled rate 7 % (95 % 2, 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4 %, < 0.1 % and < 0.1 %, respectively. No mortality related to EFTR was noted. Conclusions EFTR appears to be safe and effective for gastrointestinal lesions that are not amenable to conventional endoscopic resection. This technique should be considered as an alternative to surgery in selected cases.

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“…In these cases, salvage endoscopic resection could be a curative treatment in selected patients. Endoscopic full-thickness resection has become the treatment of choice for small T1 carcinoma in the colon or rectum [5][6][7]. In the case of fibrosis, extra careful and patient maneuvering of the specimen into the eFTR cap must be performed.…”

Section: Discussionmentioning

confidence: 99%

Salvage Endoscopic Full-Thickness Resection of Colorectal Carcinoma after Radiotherapy in a Patient Not Eligible for Surgery

Huysentruyt¹,

Schoon²,

Hossein³

et al. 2020

SCR

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For early, superficial colorectal carcinoma, endoscopic resection is an accepted curative treatment with an excellent long-term prognosis. Our report is the first report describing endoscopic full-thickness resection (eFTR) of residual recto-sigmoid carcinoma after radiotherapy. Our patient with cT2N0M0 recto-sigmoid carcinoma had been treated with radiotherapy because severe comorbidity precluded surgical resection. When the residual tumor was observed endoscopically, complete remission was achieved by endoscopic full thickness resection. There were no endoscopic or radiological signs of recurrent malignancy after the two-years follow-up period. In selected cases, eFTR after radiotherapy could be a curative treatment option.

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Endoscopic full-thickness resection for early colorectal cancer

Cited by 108 publications

References 24 publications

Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece

Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece

Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis

Salvage Endoscopic Full-Thickness Resection of Colorectal Carcinoma after Radiotherapy in a Patient Not Eligible for Surgery

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