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Endoscopy
DOI: 10.1055/a-2328-4753
Original article

Technical failure during Colorectal Endoscopic Full Thickness Resection: The “through thick and thin” Study.

Giulia Gibiino 
1   Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy (Ringgold ID: RIN18568)
2   Unit of Gastroenterology and Digestive Endoscopy, M Bufalini Hospital in Cesena, Cesena, Italy (Ringgold ID: RIN161128)
,
Cecilia Binda 
1   Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy (Ringgold ID: RIN18568)
3   Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy (Ringgold ID: RIN161128)
,
Luigi Giovanni Papparella 
4   Center for Endoscopic Research Therapeutics and training (CERTT), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy (Ringgold ID: RIN18654)
,
Cristiano Spada
4   Center for Endoscopic Research Therapeutics and training (CERTT), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy (Ringgold ID: RIN18654)
,
Gianluca Andrisani
5   Digestive Endoscopy Unit, Campus Bio-Medico University Hospital, Roma, Italy (Ringgold ID: RIN220431)
,
Francesco Di Matteo
6   Digestive Diseases, GI Endoscopy Unit, Campus Bio-Medico University Hospital, Roma, Italy (Ringgold ID: RIN220431)
,
Mario Gagliardi 
7   Digestive Endoscopy Unit, University Hospital 'San Giovanni di Dio e Ruggi d’Aragona' 'Gaetano Fucito' Location, Mercato San Severino, Italy (Ringgold ID: RIN18596)
,
Attilio Maurano
7   Digestive Endoscopy Unit, University Hospital 'San Giovanni di Dio e Ruggi d’Aragona' 'Gaetano Fucito' Location, Mercato San Severino, Italy (Ringgold ID: RIN18596)
,
Sandro Sferrazza
8   Gastroenterology and Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy (Ringgold ID: RIN367405)
,
Francesco Azzolini
9   Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Milano, Italy (Ringgold ID: RIN18985)
,
Giuseppe Grande
10   Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy (Ringgold ID: RIN208968)
,
Germana de Nucci 
11   Gastroenterology and Endoscopy Unit, Ospedale G Salvini, Garbagnate, Italy (Ringgold ID: RIN18570)
,
Paola Cesaro
12   Digestive Endoscopy Unit, Poliambulanza Brescia Hospital, Brescia, Italy (Ringgold ID: RIN18516)
,
Giovanni Aragona
13   Internal Medicine, Gastroenterology and Hepatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy (Ringgold ID: RIN18638)
,
Vincenzo Cennamo
14   Gastroenterology and Digestive Endoscopy Unit, Surgical Department, AUSL di Bologna, Bologna, Italy (Ringgold ID: RIN26217)
,
Pietro Fusaroli 
15   Gastroenterology, University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
,
Teresa Staiano
16   FPO - IRCCS - Candiolo (TO), ITALY, Istituto per la Ricerca e la Cura del Cancro di Candiolo, Candiolo, Italy (Ringgold ID: RIN18524)
,
Paola Soriani
17   Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Carpi, Italy (Ringgold ID: RIN18067)
,
Mariachiara Campanale
18   Digestive Endoscopy Unit, Galliera Hospital Trust, Genova, Italy (Ringgold ID: RIN9336)
,
Roberto Di Mitri
8   Gastroenterology and Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy (Ringgold ID: RIN367405)
,
Francesco Pugliese
19   Digestive endoscopy, Ospedale Niguarda Ca Granda, Milano, Italy (Ringgold ID: RIN9338)
,
Andrea Anderloni
20   Endoscopy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)
,
Alessandro Cucchetti
21   Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
,
Alessandro Repici
22   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (Ringgold ID: RIN437807)
23   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Carlo Fabbri
24   Digestive Endoscopy and Gastroenterology Unit, Forlì-Cesena Hospitals, Azienda Unita Sanitaria Locale della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT05913453, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Observational Cohort Retrospective Study
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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.



Publication History

Received: 09 November 2023

Accepted after revision: 16 May 2024

Accepted Manuscript online:
16 May 2024

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