Top

Techniques in Coloproctology

Published in:

01-10-2019 | Original Article

Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract

Authors: H. Albrecht, M. Raithel, A. Braun, A. Nagel, A. Stegmaier, K. Utpatel, C. Schäfer

Published in: Techniques in Coloproctology | Issue 10/2019

Abstract

Background

Endoscopic full-thickness resection (EFTR) significantly expands the spectrum of endoscopic colorectal resection methods for lesions that show no lifting sign, submucosal lesions and mucosal carcinomas. The aim of our study was to evaluate the efficacy and safety of EFTR using a commercially available full thickness resection device (FTRD) by assessing the completeness of the full-thickness resection, the technical success, as well as complications in a cohort of patients from three referral centers in Germany. Another aim was to determine which patient subpopulations benefit most in clinical practice.

Methods

This retrospective multicenter study was conducted on consecutive patients who were admitted to three referral centers in Germany between November 2014 and December 2017. The EFTR was conducted according to the standard indications using the FTRD System (OVESCO, Tübingen, Germany). Data were obtained from prospectively maintained institutional databases.

Results

There were 70 patients, 42 males and 25 females with a mean age of 79.5 years (range 25–89 years) who had colonoscopy for EFTR. In three patients EFTR was not feasible because the lesions were too large. Of the remaining 67 patients, 52 had recurrent adenomas, 10 had high-grade intraepithelial neoplasia or mucosal carcinoma and five had a subepithelial lesion. Resection was technically successful in 65 patients (97.0%). Histologically complete resection (R0) was achieved in 59/65 patients (90.8%). The R0 resection rate was lower for lesions > 20 mm (86.5%) versus lesions ≤ 20 mm (92.9%). The total complication rate was 14.9%: there was one major complication (perforation of sigmoid colon), while all other complications were minor.

Conclusions

EFTR yields excellent resection rates for benign recurrent adenomas with non-lifting sign, advanced histopathological findings or submucosal lesions when the procedure is performed in experienced hands and for the correct indication. Thus, surgery can be avoided in many cases. For all lesions the risk of R1 resection goes up with the size of the lesion and careful patient selection is mandatory.

Maguire LH, Shellito PC (2014) Endoscopic piecemeal resection of large colorectal polyps with long-term follow up. Surg Endosc 28:2641–2648CrossRef

Pellise M, Burgess NG, Tutticci N, Hourigan LF, Zanati SA, Brown GJ, Singh R, Williams SJ, Raftopoulos SC, Ormonde D, Moss A, Byth K, P’Ng H, Mahajan H, McLeod D, Bourke MJ (2017) Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions. Gut 66:644–653CrossRef

Kuroki Y, Hoteya S, Mitani T, Yamashita S, Kikuchi D, Fujimoto A, Matsui A, Nakamura M, Nishida N, Iizuka T, Yahagi N (2010) Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors. J Gastroenterol Hepatol 25:1747–1753CrossRef

Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH (2015) Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 47:829–854CrossRef

Schurr MO, Baur F, Ho CN, Anhoeck G, Kratt T, Gottwald T (2011) Endoluminal full-thickness resection of GI lesions: a new device and technique. Minim Invasive Ther Allied Technol 20:189–192CrossRef

Schmidt A, Bauerfeind P, Gubler C, Damm M, Bauder M, Caca K (2015) Endoscopic full-thickness resection in the colorectum with a novel over-the- scope device: first experience. Endoscopy 47:719–725CrossRef

Valli PV, Kaufmann M, Vrugt B, Bauerfeind P (2014) Endoscopic resection of a diverticulum-arisen colonic adenoma using a full-thickness resection device. Gastroenterology 147:969–971CrossRef

Soriani P, Tontini GE, Neumann H, de Nucci G, De Toma D, Bruni B, Vavassori S, Pastorelli L, Vecchi M, Lagoussis P (2017) Endoscopic full-thickness resection for T1 early rectal cancer: a case series and video report. Endosc Int Open 5(11):E1081–E1086CrossRef

Grauer M, Gschwendtner A, Schäfer C, Neumann H (2016) Resection of rectal carcinoids with the newly introduced endoscopic full-thickness resection device. Endoscopy 48(Suppl 1):E123–E124PubMed

10.

Schmidt A, Meier B, Caca K (2015) Endoscopic full-thickness resection: current status. World J Gastroenterol 21:9273–9285CrossRef

11.

Faehndrich M, Sandmann M (2015) Endoscopic full-thickness resection for gastrointestinal lesions using the over-the-scope clip system: a case series. Endoscopy 47:76–79

12.

Andrisani G, Pizzicannella M, Martino M, Rea R, Pandolfi M, Taffon C, Caricato M, Coppola R, Crescenzi A, Costamagna G, Di Matteo FM et al (2017) Endoscopic full-thickness resection of superficial colorectal neoplasms using a new over-the-scope clip system: a single-centre study. Dig Liver Dis 49:1009–1013CrossRef

13.

Richter-Schrag HJ, Walker C, Thimme R, Fischer A (2016) Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon. Chirurg 87:316–325CrossRef

14.

Vitali F, Naegel A, Siebler J, Neurath MF, Rath T (2018) Endoscopic full-thickness resection with an over-the-scope clip device (FTRD) in the colorectum: results from a university tertiary referral center. Endosc Int Open 6(1):E98–E103CrossRef

15.

Valli PV, Mertens J, Bauerfeind P (2018) Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD^®). Surg Endosc 32(1):289–299CrossRef

16.

Hagel AF, Boxberger F, Dauth W, Kessler HP, Neurath MF, Raithel M (2012) Colonoscopy-associated perforations—a 7 year survey on in-hospital examinations: frequency, treatment and outcome in a German university hospital. Colorectal Dis 14(9):1121–1125CrossRef

17.

Tate DJ, Desomer L, Awadie H, Goodrick K, Hourigan L, Singh R, Williams SJ, Bourke MJ (2018) EMR of laterally spreading lesions around or involving the appendiceal orifice: technique, risk factors for failure, and the outcomes of a tertiary referral cohort. Gastrointest Endosc 87(5):1279–1288CrossRef

18.

Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag HJ, Messmann H, Neuhaus H, Albers D, Birk M, Thimme R, Probst A, Faehndrich M, Frieling T, Goetz M, Riecken B, Caca K (2018) Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 67(7):1280–1289CrossRef

19.

Aepli P, Criblez D, Baumeler S, Borovicka J, Frei R (2018) Endoscopic full thickness resection (EFTR) of colorectal neoplasms with the Full Thickness Resection Device (FTRD): clinical experience from two tertiary referral centers in Switzerland. United Eur Gastroenterol J 6(3):463–470CrossRef

Title: Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract
Authors: H. Albrecht
M. Raithel
A. Braun
A. Nagel
A. Stegmaier
K. Utpatel
C. Schäfer
Publication date: 01-10-2019
Publisher: Springer International Publishing
Published in: Techniques in Coloproctology / Issue 10/2019
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-019-02043-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2019

Recalled stapler device, high complication rate, non validated scoring system and misquote from the STARR surgeons

Rectal advancement flap plus adipose lipofilling (RAFAL) for the treatment of rectourethral fistulas after radical prostatectomy

Outcomes of inflammatory bowel disease surgery in obese versus non-obese patients: a meta-analysis

Purulent meningitis as a rare complication following laparoscopic ventral rectopexy: suspected etiopathogenesis and treatment

Evaluation of the anorectal motor response after percutaneous stimulation of the posterior tibial nerve in patients with fecal incontinence

Adipose tissue grafting for management of persistent anastomotic leak after low anterior resection