Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

Dutch eFTR Group, Liselotte W Zwager, Barbara A J Bastiaansen*, Maxime E S Bronzwaer, Bas W van der Spek, G Dimitri N Heine, Krijn J C Haasnoot, Hedwig van der Sluis, Lars E Perk, Jurjen J Boonstra, Svend T Rietdijk, Hugo J Wolters, Bas L A M Weusten, Lennard P L Gilissen, W Rogier Ten Hove, Wouter B Nagengast, Frank C Bekkering, M P Schwartz, Jochim S Terhaar Sive Droste, Marije S VlugMartin H M G Houben, Francisco J Rando Munoz, Tom C J Seerden, Hanneke Beaumont, Rogier de Ridder, Evelien Dekker, Paul Fockens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background Endoscopic full-thickness resection (eFTR) is a minimally invasive resection technique that allows definite diagnosis and treatment for complex colorectal lesions

Methods Consecutive patients undergoing eFTR in 20 hospitals were prospectively included. The primary outcome was technical success, defined as macroscopic complete en bloc resection. Secondary outcomes were: clinical success, defined as tumor-free resection margins (R0 resection); full-thickness resection rate; and adverse events.

Results Between July 2015 and October 2018, 367 procedures were included. Indications were difficult polyps (non-lifting sign and/or difficult location; n = 133), primary resection of suspected T1 colorectal cancer (CRC; n = 71), reresection after incomplete resection of T1 CRC (n = 150), and subepithelial tumors (n = 13). Technical success was achieved in 308 procedures (83.9%). In 21 procedures (5.7 %), eFTR was not performed because the lesion could not be reached or retracted into the cap. In the remaining 346 procedures, R0 resection was achieved in 285 (82.4%) and full-thickness resection in 288 (83.2%). The median diameter of resected specimens was 23mm. Overall adverse event rate was 9.3% (n = 34/367): 10 patients (2.7 %) required emergency surgery for five delayed and two immediate perforations and three cases of appendicitis.

Conclusion eFTR is an effective and relatively safe en bloc resection technique for complex colorectal lesions with the potential to avoid surgery. Further studies assessing the role of eFTR in early CRC treatment with long-term outcomes are needed.

Original languageEnglish
Pages (from-to)1014-1023
Number of pages10
JournalEndoscopy
Volume52
Issue number11
Early online date4-Jun-2020
DOIs
Publication statusPublished - Nov-2020

Keywords

  • SUBMUCOSAL DISSECTION
  • ADVERSE EVENTS
  • NEOPLASMS
  • METAANALYSIS
  • OUTCOMES
  • CANCER
  • EMR

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