Y Ichkhanian1, K Vosoughi1, D L Diehl2, I S Grimm3, T W James3, A W Templeton4, K Hajifathalian5, J L Tokar6, J B Samarasena7, N El Hage Chehade7, J Lee7, K Chang7, M Mizrahi8, M Barawi9, S Irani10, S Friedland11, P Korc12, A A Aadam13, M A Al-Haddad14, T E Kowalski15, A Novikov15, G Smallfield16, G G Ginsberg17, V M Oza18, D Panuu19, N Fukami20, H Pohl21, Michael Lajin22, N A Kumta23, S J Tang24, Y M Naga24, S K Amateau25, G O I Brewer1, V Kumbhari1, R Sharaiha5, Mouen A Khashab26,27. 1. Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA. 2. Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA, USA. 3. Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA. 4. Department of Gastroenterology, University of Washington, Seattle, WA, USA. 5. Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. 6. Fox Chase Cancer Center, Philadelphia, PA, USA. 7. H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, CA, USA. 8. Department of Internal Medicine, Division of Gastroenterology, Center for Advanced Endoscopy, University of South Alabama, Mobile, AL, USA. 9. Division of Gastroenterology and Hepatology, St. John Hospital and Medical Center, Detroit, MI, USA. 10. Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA. 11. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA. 12. Department of Medicine, Division of Gastroenterology, Hoag Hospital, Newport Beach, CA, USA. 13. Division of Gastroenterology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA. 14. Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. 15. Thomas Jefferson University, Philadelphia, PA, USA. 16. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA. 17. Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 18. Division of Gastroenterology and Hepatology, University of South Carolina, Greenville, SC, USA. 19. McLeod Regional Medical Center, Florence, SC, USA. 20. Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA. 21. VA White River Junction, White River Junction, VT, USA. 22. SHARP Grossmont Hospital, La Mesa, CA, USA. 23. Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 24. Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA. 25. Division of Gastroenterology, University of Minnesota, Minneapolis, MN, USA. 26. Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA. mkhasha1@jhmi.edu. 27. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Bldg, 1800 Orleans Street, Suite 7125G, Baltimore, MD, 21287, USA. mkhasha1@jhmi.edu.
Abstract
BACKGROUND: Introduction of the full-thickness resection device (FTRD) has allowed endoscopic resection of difficult lesions such as those with deep wall origin/infiltration or those located in difficult anatomic locations. The aim of this study is to assess the outcomes of the FTRD among its early users in the USA. METHODS: Patients who underwent endoscopic full-thickness resection (EFTR) for lower gastrointestinal tract lesions using the FTRD at 26 US tertiary care centers between 10/2017 and 12/2018 were included. Primary outcome was R0 resection rate. Secondary outcomes included rate of technical success (en bloc resection), achievement of histologic full-thickness resection (FTR), and adverse events (AE). RESULTS: A total of 95 patients (mean age 65.5 ± 12.6 year, 38.9% F) were included. The most common indication, for use of FTRD, was resection of difficult adenomas (non-lifting, recurrent, residual, or involving appendiceal orifice/diverticular opening) (66.3%), followed by adenocarcinomas (22.1%), and subepithelial tumors (SET) (11.6%). Lesions were located in the proximal colon (61.1%), distal colon (18.9%), or rectum (20%). Mean lesion diameter was 15.5 ± 6.4 mm and 61.1% had a prior resection attempt. The mean total procedure time was 59.7 ± 31.8 min. R0 resection was achieved in 82.7% while technical success was achieved in 84.2%. Histologically FTR was demonstrated in 88.1% of patients. There were five clinical AE (5.3%) with 2 (2.1%) requiring surgical intervention. CONCLUSIONS: Results from this first US multicenter study suggest that EFTR with the FTRD is a technically feasible, safe, and effective technique for resecting difficult colonic lesions.
BACKGROUND: Introduction of the full-thickness resection device (FTRD) has allowed endoscopic resection of difficult lesions such as those with deep wall origin/infiltration or those located in difficult anatomic locations. The aim of this study is to assess the outcomes of the FTRD among its early users in the USA. METHODS:Patients who underwent endoscopic full-thickness resection (EFTR) for lower gastrointestinal tract lesions using the FTRD at 26 US tertiary care centers between 10/2017 and 12/2018 were included. Primary outcome was R0 resection rate. Secondary outcomes included rate of technical success (en bloc resection), achievement of histologic full-thickness resection (FTR), and adverse events (AE). RESULTS: A total of 95 patients (mean age 65.5 ± 12.6 year, 38.9% F) were included. The most common indication, for use of FTRD, was resection of difficult adenomas (non-lifting, recurrent, residual, or involving appendiceal orifice/diverticular opening) (66.3%), followed by adenocarcinomas (22.1%), and subepithelial tumors (SET) (11.6%). Lesions were located in the proximal colon (61.1%), distal colon (18.9%), or rectum (20%). Mean lesion diameter was 15.5 ± 6.4 mm and 61.1% had a prior resection attempt. The mean total procedure time was 59.7 ± 31.8 min. R0 resection was achieved in 82.7% while technical success was achieved in 84.2%. Histologically FTR was demonstrated in 88.1% of patients. There were five clinical AE (5.3%) with 2 (2.1%) requiring surgical intervention. CONCLUSIONS: Results from this first US multicenter study suggest that EFTR with the FTRD is a technically feasible, safe, and effective technique for resecting difficult colonic lesions.
Authors: Irmengard Krutzenbichler; Markus Dollhopf; Helmut Diepolder; Andreas Eigler; Martin Fuchs; Simon Herrmann; Gerhard Kleber; Björn Lewerenz; Christoph Kaiser; Tilman Lilje; Timo Rath; Ayman Agha; Francesco Vitali; Claus Schäfer; Wolfgang Schepp; Felix Gundling Journal: Surg Endosc Date: 2020-07-09 Impact factor: 4.584