Endoscopy 2019; 51(04): S114-S115
DOI: 10.1055/s-0039-1681507
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 11:00 – 13:00: Best abstract awards Congress Hall
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC FULL-THICKNESS RESECTION OF COLORECTAL LESIONS – A DUTCH NATIONWIDE PROSPECTIVE COHORT STUDY

, , on behalf of the Dutch eFTR Group
LW Zwager
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
,
MES Bronzwaer
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
,
BW van der Spek
2   Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, Netherlands
,
GDN Heine
2   Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, Netherlands
,
KJC Haasnoot
2   Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, Netherlands
,
H van der Sluis
3   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, Netherlands
,
LE Perk
4   Department of Gastroenterology and Hepatology, Haaglanden Medical Center, Den Haag, Netherlands
,
JJ Boonstra
5   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
,
ST Rietdijk
6   Department of Gastroenterology and Hepatology, OLVG, Amsterdam, Netherlands
,
HJ Wolters
7   Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, Netherlands
,
BLAM Weusten
8   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
,
LPL Gilissen
9   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands
,
WR ten Hove
10   Department of Gastroenterology and Hepatology, Alrijne Medical Group, Leiden, Netherlands
,
WB Nagengast
11   Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, Netherlands
,
FC Bekkering
12   Department of Gastroenterology and Hepatology, Ijsselland Hospital, Capelle aan den IJssel, Netherlands
,
MP Schwartz
13   Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, Netherlands
,
P Fockens
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
,
BAJ Bastiaansen
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

A subset of colorectal lesions is not suitable for conventional endoscopic resection because of increased risk for incomplete resection or perforation. Recently, endoscopic full-thickness resection (eFTR) was introduced to allow definite diagnosis and radical treatment of lesions that otherwise might have required surgical resection. We prospectively evaluated all eFTR procedures performed in the Netherlands with the full-thickness resection device (FTRD, Ovesco Endoscopy, Tübingen, Germany).

Methods:

All patients undergoing eFTR between September 2015 and October 2018 in 22 hospitals were included. To determine the technical success, we studied the number of macroscopic complete en bloc resections. Secondary outcomes were: histologically confirmed radical (R0) resections, full-thickness resections and adverse events. Standard descriptive statistics were used.

Results:

This prospective multicenter study included 401 procedures. The mean age was 69 ± 8.6 years and 62.6% of the patients was male. eFTR was performed for primary resection of T1 CRCs (n = 79), re-resection after previous (potentially) incomplete resection for T1 CRCs (n = 159), difficult adenomas (n = 146), submucosal tumors (n = 15) and for suspected motility disorders (n = 2). Technical success of all initiated procedures was achieved in 83.5% (n = 335/401). In 5.5% (n = 22/401) no histology could be obtained because the lesion either could not be reached or could not be retracted into the cap. R0 resection in the 379 cases amenable to eFTR was 79.7% (n = 302/379) and full-thickness resection was confirmed in 82.8% (n = 314/379). The median diameter of the resected specimen was 23.4 mm (range 5 – 45). Overall adverse event rate was 9.2% (n = 37/401) of which 2.7% (n = 11/401) required emergency surgery for 2 immediate perforations, 5 delayed perforations and 4 cases of appendicitis.

Conclusions:

Endoscopic full-thickness resection was technically successful in over 80% of procedures with an acceptable complication rate. The issue of delayed perforations needs further assessment as well as the risk for secondary appendicitis in appendiceal polyp cases.