CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(10): E1227-E1234
DOI: 10.1055/a-0672-1138
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety

Bas van der Spek*
1   Department of Gastroenterology and Hepatology, Northwest Hospital group, Alkmaar, The Netherlands
,
Krijn Haasnoot*
1   Department of Gastroenterology and Hepatology, Northwest Hospital group, Alkmaar, The Netherlands
,
Christof Meischl
2   Department of Pathology, Symbiant, Pathology Expert Centre/Northwest Hospital group, Alkmaar, The Netherlands
,
Dimitri Heine
1   Department of Gastroenterology and Hepatology, Northwest Hospital group, Alkmaar, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 09 February 2018

accepted after revision 04 July 2018

Publication Date:
08 October 2018 (online)

Abstract

Background and study aims Endoscopic full-thickness resection (eFTR) allows en-bloc and transmural resection of colorectal lesions for which other advanced endoscopic techniques are unsuitable. We present our experience with a novel “clip first, cut later” eFTR-device and evaluate its indications, efficacy and safety.

Patients and methods From July 2015 through October 2017, 51 eFTR-procedures were performed in 48 patients. Technical success and R0-resection rates were prospectively recorded and retrospectively analyzed.

Results Indications for eFTR were non-lifting adenoma (n = 19), primary resection of malignant lesion (n = 2), resection of scar tissue after incomplete endoscopic resection of low-risk T1 colorectal carcinoma (n = 26), adenoma involving a diverticulum (n = 2) and neuroendocrine tumor (n = 2). Two lesions were treated by combining endoscopic mucosal resection and eFTR. Technical success was achieved in 45 of 51 procedures (88 %). Histopathology confirmed full-thickness resection in 43 of 50 specimens (86 %) and radical resection (R0) in 40 procedures (80 %). eFTR-specimens, obtained for indeterminate previous T1 colorectal carcinoma resection, were free of residual carcinoma in 25 of 26 cases (96 %). In six patients (13 %) a total of eight adverse events occurred within 30 days after eFTR. One perforation occurred, which was corrected endoscopically. No emergency surgery was necessary.

Conclusion In this study eFTR appears to be safe and effective for the resection of colorectal lesions. Technical success, R0-resection and major adverse events rate were reasonable and comparable with eFTR data reported elsewhere. Mean specimen diameter (23 mm) limits its use to relatively small lesions. A clinical algorithm for eFTR case selection is proposed. eFTR ensured local radical excision where other endoscopic techniques did not suffice and reduced the need for surgery in selected cases.

* These authors contributed equally.


 
  • References

  • 1 Schmidt A, Bauerfeind P, Gubler C. et al. Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy 2015; 47: 719-725
  • 2 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289
  • 3 Schmidt A, Meier B, Caca K. Endoscopic full-thickness resection: Current status. World J Gastroenterol 2015; 21: 9273-9285
  • 4 Richter-Schrag HJ, Walker C, Thimme R. et al. Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon. Chirurg 2016; 87: 316-325
  • 5 Andrisani G, Pizzicannella M, Martino M. et al. Endoscopic full-thickness resection of superficial colorectal neoplasms using a new over-the-scope clip system: A single-centre study. Dig Liver Dis 2017; 49: 1009-1013
  • 6 Valli PV, Mertens J, Bauerfeind P. Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD®). Surg Endosc 2018; 32: 289-299
  • 7 Castor Electronic Data Capture. Ciwit BV. Amsterdam, The Netherlands: 2018
  • 8 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
  • 9 Vleugels JLA, Hazewinkel Y, Dekker E. Morphological classifications of gastrointestinal lesions. Best Pract Res Clin Gastroenterol 2017; 31: 359-367
  • 10 Caputo A, Schmidt A, Caca K. et al. Efficacy and safety of the remOVE System for OTSC® and FTRD® clip removal: Data from a PMCF analysis. Minim Invasive Ther Allied Technol 2018; 27: 138-142
  • 11 Bosch SL, Teerenstra S, de Wilt JH. et al. Predicting lymph node metastasis in pT1 colorectal cancer: A systematic review of risk factors providing rationale for therapy decisions. Endoscopy 2013; 45: 827-834
  • 12 Labianca R, Nordlinger B, Beretta GD. et al. Early colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 (Suppl. 06) vi64-72
  • 13 Backes Y, de Vos Tot Nederveen Cappel WH, van Bergeijk J. et al. Risk for incomplete resection after macroscopic radical endoscopic resection of T1 colorectal cancer: A multicenter cohort study. Am J Gastroenterol 2017; 112: 785-796
  • 14 Van Leersum NJ, Snijders HS, Henneman D. et al. The Dutch surgical colorectal audit. Eur J Surg Oncol 2013; 39: 1063-1070
  • 15 Morris EJ, Whitehouse LE, Farrell T. et al. A retrospective observational study examining the characteristics and outcomes of tumours diagnosed within and without of the English NHS Bowel Cancer Screening Programme. Br J Cancer 2012; 107: 757-64
  • 16 De Neree Tot Babberich MP, van der Willik EM, van Groningen JT. et al. Surgery for colorectal cancer since the introduction of the Netherlands national screening programme. Investigations into changes in number of resections and waiting times for surgery. Ned Tijdschr Geneeskd 2017; 161: D997
  • 17 Lagoussis P, Soriani P, Tontini GE. et al. Over-the-scope clip-assisted endoscopic full-thickness resection after incomplete resection of rectal adenocarcinoma. Endoscopy 2016; 48 (Suppl. 01) E59-60