The use of Endoscopic Full Thickness Resection can avoid surgical resection in benign colorectal pathology: A retrospective review in the South-Eastern Health and Social Care Trust, Northern Ireland

Aims Endoscopic full thickness resection (eFTR) is an advanced endoscopic technique for resection of complex gastrointestinal lesions. We aim to report outcomes for patients undergoing eFTR who were identified as having recurrent polyps despite repeat endoscopic attempts at clearance, lesions that appeared suspicious for malignancy on eFTR but were benign on subsequent histological assessment, or other benign indications. These patients in our trust would historically have been referred for consideration of surgical intervention.

Methods A retrospective review was carried out on all patients having eFTR performed in benign colorectal disease in the South-Eastern Health and Social Care Trust. Data was collected for patients referred from October 2018 to April 2023 inclusive. Patients were identified via the Trust SharePoint dataset, theatre management system (TMS©) and the electronic care record (ECR©). All patients were discussed at the significant polyp early colorectal cancer (SPECC) multidisciplinary team meeting pre-procedure and following results of histology with follow-up arranged as per local guidelines. Primary outcome measures included were need for surgical intervention, recurrence rate and complication rate.

Results A total of 21 patients were identified. All procedures were carried out as day procedures with conscious sedation and no anaesthetist.

6 of these patients underwent a hybrid EMR/eFTR approach for polyps that had a suspicious appearance for malignancy after EMR. Median age was 76 years (range 65-88 years). Median polyp size was 35mm (range 10-60mm). One patient (16.7%) had recurrence on follow-up scope which was managed successfully by EMR.

13 of these patients underwent eFTR for recurrent benign polyps. The median age was 72 (range 43-83 years). Median polyp size was 30mm (range 10-60mm). 3 (23.1%) had recurrence on follow-up scopes, with one patient managed by EMR, one by repeat eFTR and one felt to be too frail for any further follow-up.

One patient had eFTR of appendiceal stump for repeat appendicitis, and one patient had eFTR for exclusion of Hirschprung’s disease.

None of the 21 patients required surgical intervention following eFTR.

One patient (4.8%) required overnight admission for observation but was managed conservatively and discharged the following day. There were no episodes of clinically significant bleeding or perforation requiring surgical intervention.

Conclusions eFTR is a safe and effective method for management of benign colorectal disease in the context of a multi-disciplinary team. It can be used for definitive treatment of recurrent benign polyp disease, Hirschprung’s exclusion, recurrent appendiceal stump inflammation and for accurate histological staging of ultimately benign complex polyps that previously would have required surgical resection.

Long-term follow-up data on these patients is required.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

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Artikel online veröffentlicht:
15. April 2024