Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece

Magdalini Velegraki; Artemis Trikola; Konstantinos Vasiliadis; Maria Fragaki; Afroditi Mpitouli; Ioannis Dimas; Evangelos Voudoukis; Elpida Giannikaki; Amalia Kapranou; Athanasios Kordelas; Gerasimos Stefanidis; Gregorios Paspatis

Authors Magdalini Velegraki, Artemis Trikola, Konstantinos Vasiliadis, Maria Fragaki, Afroditi Mpitouli, Ioannis Dimas, Evangelos Voudoukis, Elpida Giannikaki, Amalia Kapranou, Athanasios Kordelas, Gerasimos Stefanidis, Gregorios Paspatis.

Abstract

Background Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD) is an invasive treatment for colorectal lesions not resectable by conventional endoscopic techniques. This study presents the first Greek experience of the FTRD procedure, assessing the efficacy and safety of EFTR.

Methods We conducted a retrospective analysis of 17 consecutive patients treated with the FTRD at 2 referral centers from October 2015 through December 2018. The indications included difficult adenomas (non-lifting and/or at difficult locations), early adenocarcinomas and subepithelial tumors. Primary endpoints were technical success and R0 resection.

Results Technical success and R0 resection were achieved in 82.3% procedures (14/17) and in 87.5% of those with difficult adenomas (8 patients). In the subgroup with carcinomas (n=3), the rate of technical success and R0 resection was 66.6%, while in the subgroup with subepithelial tumors (n=6) the rate was 83.3%. Technical success and R0 resection were significantly lower for lesions >20 mm vs. ≤20 mm (P=0.0429). In the 17 patients a total of 3 adverse events occurred (17.6%) and one of the patients underwent laparoscopic appendectomy because of EFTR around the appendix.

Conclusions Our study showed favorable results concerning EFTR feasibility, efficacy and safety, especially for lesions ≤20 mm, non-lifting adenomas, and subepithelial tumors. Technical success, R0 resection, and adverse events rates were comparable with previously published data. Larger randomized studies are needed to better define the clinical benefit and long-term outcomes of EFTR in selected patients.

Keywords Colorectal adenoma, colorectal adenocarcinoma, endoscopic full-thickness resection, full-thickness resection device

Ann Gastroenterol 2019; 32 (5): 482-488