Recent advances and current challenges in endoscopic resection with the full-thickness resection device

Mun, Elijah J.; Wagh, Mihir S.

doi:10.3748/wjg.v29.i25.4009

Cited by 2 publications

(1 citation statement)

References 46 publications

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“…In conclusion, we conducted the first multicentre study showing that unpredictable technical issues can complicate EFTR procedure and must be considered in all cases, despite the recognized safety profile [29]. The proposal for a classification is to invite all endoscopists who perform this procedure to share a single language and merge data from national registries.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Gibiino,

Binda,

Papparella

et al. 2024

Endoscopy

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Background: Endoscopic full-thickness resection (EFTR) is an effective and safe technique for non-lifting colorectal lesions. Technical issues or failures with full-thickness resection device (FTRD) system are reported but there are no data about their details. The aim of our study was to quantify and classify FTRD technical failures. Patients and methods: We performed a retrospective study involving 17 Italian centres with experience in advanced resection techniques and OVESCO devices. Each centre shared and classified all the consecutive failures prospectively collected during colorectal EFTR by using FTRD from 2018 to 2022. Primary outcome was technical failure rate and classification; secondary outcomes included management, clinical success, and complications’ assessment in this population. Results: Included lesions were mainly recurrent (52%), with mean dimension of 18.4 (± 7.5) mm. Among 750 EFTRs, failures occurred in 77 patients (35 F, mean age 68.9 ±8.9 years). A classification was proposed in type I snare uncutting (53.2%), type II clip misdeployment (31.2%) and type III cap misplacement (15.6%). Among endoscopic treatment completed, rescue EMR was performed in 57 patients (79%), allowing en-bloc and R0 resection in 71% and 64% cases, respectively. Overall adverse events rate was 27.3%. Pooled estimates for the rate of failure, complications and rescue endoscopic therapy were similar between low- and high-volume centres (p=0.08, p = 0.702 and p= 0.713). Conclusions: Colorectal EFTR with FTRD is a challenging technique with a not negligible rate of technical failure and complications. Experience in rescue resection techniques and multidisciplinary management are mandatory in this setting.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Gibiino,

Binda,

Papparella

et al. 2024

Endoscopy

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Meta-Analysis of Endoscopic Full-Thickness Resection Versus Endoscopic Submucosal Dissection for Complex Colorectal Lesions

Singh,

Mohan,

Vinayek

et al. 2024

Journal of Clinical Gastroenterology

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Background: Studies evaluating endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD) for complex colorectal lesions have shown variable results. We conducted a meta-analysis of the available data. Methods: Online databases were searched for studies comparing EFTR versus ESD for complex colorectal lesions. The outcomes of interest were resection rates, procedure time (min), and complications. Pooled odds ratios (OR) and standardized mean difference (SMD) along with 95% CI were calculated. Results: A total of 4 studies with 530 patients (n=215 EFTR, n=315 ESD) were included. The mean follow-up duration was 5 months. The mean age of the patients was 68 years and 64% were men. The EFTR and ESD groups had similar rates of en bloc resection (OR: 1.73, 95% CI: 0.60-4.97, P=0.31) and R0 resection (OR: 1.52, 95% CI: 0.55-4.14, P=0.42). The EFTR group had significantly reduced procedure time (SMD -1.87, 95% CI: -3.13 to -0.61, P=0.004), total complications (OR: 0.24, 95% CI: 0.13-0.44, P<0.00001), perforation (OR: 0.12, 95% CI: 0.03-0.39, P=0.0005) and postresection electrocoagulation syndrome (OR: 0.06, 95% CI: 0.01-0.48, P=0.008). Delayed bleeding was similar in the 2 groups (OR: 0.80, 95% CI: 0.30-2.12, P=0.66). Residual/recurrent lesions were significantly higher in the EFTR group (OR: 4.67, 95% CI: 1.39-15.66, P=0.01). Discussion: This meta-analysis of small studies with high heterogeneity showed that EFTR and ESD have comparable resection rates for complex colorectal lesions. EFTR is faster and has fewer complications, but it increases residual or recurrent lesions.

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Recent advances and current challenges in endoscopic resection with the full-thickness resection device

Cited by 2 publications

References 46 publications

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Meta-Analysis of Endoscopic Full-Thickness Resection Versus Endoscopic Submucosal Dissection for Complex Colorectal Lesions

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