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

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.

Now, More than Ever Before, Colonoscopy Is a Therapeutic Procedure

“…Technical success, defined as reaching the lesion, deploying the clip and performing an en bloc and macroscopically complete resection, and histologically complete (R0) resection was achieved in all patients. These rates of technical success and R0 resection are higher than previously reported, which range from 75 to 100% [7, 8, 16, 17] and from 75 to 83% [7, 8], respectively. No major complications were described, and only a minority reported abdominal pain.…”

“…It is not unlikely that the clips used for EFTR promote a foreign-body reaction inducing granulation tissue that endoscopically could appear as large nodular pseudopolyps mimicking adenomatous tissue [7]. In this study, colonoscopy results were available in 6 patients in whom no residual lesion was detected.…”

“…Apart from these indications, EFTR may also be used for early carcinomas with indication for endoscopic resection, fibrotic lesions that have been previously sampled, small subepithelial tumors, and lesions located in difficult anatomic places where the perforation risk is significant (e.g., para-diverticular or para-appendicular lesions) [7]. It could also be a valid alternative for patients who would otherwise qualify for surgical resection but are poor surgical candidates [8].…”

“…This required the subsequent resection of the lesions with a conventional snare, an occurrence previously reported [7, 8]. …”

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

“…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.…”