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

Aims Endoscopic full-thickness resection (EFTR) is emerging as an effective and safe technique for non-lifting colorectal lesions. Technical failures with full-thickness resection device (FTRD) system are reported but there are no data about their details or subconsequent management. The aim of the study is to assess technical failure rate, unexpected events types and their management.

Methods This is a retrospective study involving 14 high-volume Italian centres with experience in advanced resection techniques. Each centre was invited to analyse all the consecutive failures during colorectal EFTR by using FTRD from 2014 to 2022. The primary outcome was technical failure rate; secondary outcomes included management, clinical success, and complications’ assessment in this population [1] [2] [3] [4] [5] [6] [7] [8] [9] [10].

Results Among 503 procedures, technical failure rate was 11% (55 cases, 33M, mean age 70 years). Lesions were mainly recurrent or residual (56%), in the right colon (50%) and with mean dimension of 17 mm. Failure was linked to cap-positioning in 12 (22%), over-the-scope-clip (OTS-clip) misdeployment in 21 (38 %) and snare dysfunction in 22 (40%) cases. Among 52 lesions completed, EMR was the rescue technique in 37 patients (71%), allowing en-bloc resection rate of 70% and curative margins (R0) in 65% cases. Intraprocedural bleeding and perforation rate were both 13%. Adverse events affected 19% of patients.

Conclusions Our study confirmed that colorectal EFTR is a challenging procedure with unpredictable technical failure and a wide spectrum of consequences. Experience in rescue resection techniques and multidisciplinary management are mandatory in this setting.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

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Publication History

Article published online:
14 April 2023