Hybrid endoscopic approaches for complex colorectal polyps with a non-lifting sign: the Greek experience

Georgios Tribonias; Magdalini Velegraki; Maria Tzouvala; Maria Fragaki; Pinelopi Nikolaou; Nikolaos Leontidis; Despoina Arna; Andreas Psistakis; Georgia Mpellou; Maria Palatianou; Ioannis Psaroudakis; Antonios Neokleous; Gregorios Paspatis

Authors Georgios Tribonias, Magdalini Velegraki, Maria Tzouvala, Maria Fragaki, Pinelopi Nikolaou, Nikolaos Leontidis, Despoina Arna, Andreas Psistakis, Georgia Mpellou, Maria Palatianou, Ioannis Psaroudakis, Antonios Neokleous, Gregorios Paspatis.

Abstract

Background Hybrid approaches combining endoscopic full-thickness resection (EFTR) with conventional techniques (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD]) have enabled the resection of difficult fibrotic colorectal adenomas exhibiting a “non-lifting” sign, and polyps in difficult positions. We present our cohort treated with either EMR+EFTR or ESD+EFTR as salvage hybrid endoscopic approaches for complex colorectal polyps not amenable to conventional techniques.

Methods Retrospective analysis included technical success, histological confirmation of marginfree resection, assessment of adverse events and follow up with histological assessment. All patients underwent follow-up endoscopy at least 6 and 12 months post-resection.

Results Fourteen patients underwent hybrid EFTR procedures (11 EMR+EFTR and 3 ESD+EFTR). Technical success was achieved in all cases where the full-thickness resection device (FTRD) was advanced to the site of the resection (100%). In 2 cases, the FTRD system could not be passed through the sigmoid colon because of severe chronic diverticulitis, subsequent fibrosis and stiffness. The mean lesion size in the EMR+EFTR group (41.7 mm; range 20-50 mm) was larger than the ESD+EFTR group (31.7 mm; range 30-35 mm). Six patients (42.9%) were histologically diagnosed with T1 carcinoma. The mean duration of hospitalization was 1.4 days. Follow-up endoscopy was available in all patients and no recurrence was observed with histological confirmation during a mean follow-up period of 15.4 months.

Conclusion Hybrid procedures appear to be safe and effective treatments for complex colorectal lesions not amenable to EMR, ESD or EFTR alone, because of the lesion size, positive non-lifting sign, and difficult positions.

Keywords Polyp, endoscopic submucosal dissection, endoscopic mucosal resection, endoscopic full-thickness resection, full-thickness resection device

Ann Gastroenterol 2024; 37 (4): 476-484