Endoscopic full-thickness resection using full-thickness resection device for treatment of upper and lower gastrointestinal tract lesions-the first New Zealand study

Abstract

Aim: The full-thickness resection device (FTRD) offers an innovative treatment approach for lesions unsuitable for traditional endoscopic resection. This study evaluates FTRD's safety and efficacy for resection of upper and lower gastrointestinal tract lesions in New Zealand, where data are currently lacking.

Method: This multicentre retrospective study included patients who underwent FTRD at Middlemore Hospital and North Shore Hospital between 1 January 2017 and 30 April 2023. Histology and post-procedural complications up to 30 days were collated. Ethics approval and locality assessment were granted.

Results: A total of 51 patients-18 males (35%) and 33 (65%) females-with a mean age of 63.5 years were included. Five lesions were upper gastrointestinal (four gastric body; one duodenal) and 46 were colonic cases (20 appendiceal orifice lesions; five caecal; four from hepatic flexure; two each at sigmoid, ascending and transverse colon; one descending colon and 10 from the rectum). Technically successful FTRD deployment was achieved in 86% (n=44), with negative histological margins (R0 resection) seen in 82% (n=31). Thirteen patients were excluded from this calculation, as histological clearance was not applicable. Procedure-related complications occurred in 12% (n=6): there were three appendicitis cases; one experienced delayed bleeding requiring blood transfusion and endoscopic management; and two experienced technical complications (one snare entrapment and one clip entrapment).

Conclusion: This study demonstrates our experience with FTRD in New Zealand with technical success and R0 resection rates similar to the published literature. There is a considerable adverse event rate that requires careful patient discussion and consent prior to selection of this procedure.