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. 2021 Jul;35(7):3339-3353.
doi: 10.1007/s00464-020-07772-5. Epub 2020 Jul 9.

Technical success, resection status, and procedural complication rate of colonoscopic full-wall resection: a pooled analysis from 7 hospitals of different care levels

Irmengard Krutzenbichler #  1 , Markus Dollhopf #  2 , Helmut Diepolder  3 , Andreas Eigler  4 , Martin Fuchs  1 , Simon Herrmann  2 , Gerhard Kleber  5 , Björn Lewerenz  1 , Christoph Kaiser  4 , Tilman Lilje  3 , Timo Rath  6 , Ayman Agha  7 , Francesco Vitali  6 , Claus Schäfer  8 , Wolfgang Schepp  1 , Felix Gundling  9   10
Affiliations

Technical success, resection status, and procedural complication rate of colonoscopic full-wall resection: a pooled analysis from 7 hospitals of different care levels

Irmengard Krutzenbichler et al. Surg Endosc. 2021 Jul.

Abstract

Introduction: Endoscopic full-thickness resection (eFTR) using the full-thickness resection device (FTRD®) is a novel minimally invasive procedure that allows the resection of various lesions in the gastrointestinal tract including the colorectum. Real-world data outside of published studies are limited. The aim of this study was a detailed analysis of the outcomes of colonoscopic eFTR in different hospitals from different care levels in correlation with the number of endoscopists performing eFTR.

Material and methods: In this case series, the data of all patients who underwent eFTR between November 2014 and June 2019 (performed by a total of 22 endoscopists) in 7 hospitals were analyzed retrospectively regarding rates of technical success, R0 resection, and procedure-related complications.

Results: Colonoscopic eFTR was performed in 229 patients (64.6% men; average age 69.3 ± 10.3 years) mainly on the basis of the following indication: 69.9% difficult adenomas, 21.0% gastrointestinal adenocarcinomas, and 7.9% subepithelial tumors. The average size of the lesions was 16.3 mm. Technical success rate of eFTR was achieved in 83.8% (binominal confidence interval 78.4-88.4%). Overall, histologically complete resection (R0) was achieved in 77.2% (CI 69.8-83.6%) while histologically proven full-wall excidate was confirmed in 90.0% (CI 85.1-93.7%). Of the resectates obtained (n = 210), 190 were resected en bloc (90.5%). We did not observe a clear improvement of technical success and R0 resection rate over time by the performing endoscopists. Altogether, procedure-related complications were observed in 17.5% (mostly moderate) including 2 cases of acute gangrenous appendicitis requiring operation.

Discussion: In this pooled analysis, eFTR represents a feasible, effective, and safe minimally invasive endoscopic technique.

Keywords: Endoscopic full-thickness resection (eFTR); Endoscopic resection; Full-thickness resection device (FTRD®); Polypectomy; ‘WALL RESECT’.

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Conflict of interest statement

Irmengard Krutzenbichler, Dr. Markus Dollhopf, Prof. Dr. Helmut Diepolder, Prof. Dr. Andreas Eigler, Dr. Martin Fuchs, Simon Herrmann, Prof. Dr. Gerhard Kleber, Dr. Björn Lewerenz, Dr. Christoph Kaiser, Dr. Tillmann Lillje, Prof. Dr. Timo Rath, Prof. Dr. Ayman Agha, Dr. Francesco Vitali, Prof. Dr. Claus Schäfer, Prof. Dr. Wolfgang Schepp, and PD Dr. Felix Gundling have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Overview of results of the whole study collective is shown as a flow chart. Lesions that required close follow-up or surgery were qualified as "risk lesions"
Fig. 2
Fig. 2
A Endoscopic image of the non-lifting adenoma involving the appendiceal orifice (diameter of lesion approximately 20 mm), B Lateral markings before full-thickness resection (FTRD), C Endoscopic view showing the resection site with FTRD clip securing perforation closure of colonic wall; D Resection specimen pinned down on rubber foam before immersion in formalin ( source: Bogenhausen hospital)
Fig. 3
Fig. 3
A–D Correlation of technical success and R0 resection rate with experience (assessed by volume of eFTR over time, A, B) and number of endoscopists performing FTRD procedures (C, D). Lesions that required close follow-up or surgery were qualified as "risk lesions"
See this image and copyright information in PMC

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