Liselotte W Zwager1, Barbara A J Bastiaansen1, Maxime E S Bronzwaer1, Bas W van der Spek2, G Dimitri N Heine2, Krijn J C Haasnoot3, Hedwig van der Sluis4, Lars E Perk5, Jurjen J Boonstra6, Svend T Rietdijk7, Hugo J Wolters8, Bas L A M Weusten9, Lennard P L Gilissen10, W Rogier Ten Hove11, Wouter B Nagengast12, Frank C Bekkering13, M P Schwartz14, Jochim S Terhaar Sive Droste15, Marije S Vlug16, Martin H M G Houben17, Francisco J Rando Munoz18, Tom C J Seerden19, Hanneke Beaumont20, Rogier de Ridder21, Evelien Dekker1, Paul Fockens1. 1. Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, The Netherlands. 3. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. 4. Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands. 5. Department of Gastroenterology and Hepatology, Haaglanden Medical Center, The Hague, The Netherlands. 6. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. 8. Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, The Netherlands. 9. Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands. 10. Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands. 11. Department of Gastroenterology and Hepatology, Alrijne Medical Group, Leiden, The Netherlands. 12. Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands. 13. Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands. 14. Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands. 15. Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands. 16. Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, The Netherlands. 17. Department of Gastroenterology and Hepatology, Haga Teaching Hospital, The Hague, The Netherlands. 18. Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, The Netherlands. 19. Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands. 20. Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU, Amsterdam, The Netherlands. 21. Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
Abstract
BACKGROUND: Endoscopic full-thickness resection (eFTR) is a minimally invasive resection technique that allows definite diagnosis and treatment for complex colorectal lesions ≤ 30 mm unsuitable for conventional endoscopic resection. This study reports clinical outcomes from the Dutch colorectal eFTR registry. 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), re-resection 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 23 mm. 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. Thieme. All rights reserved.
BACKGROUND: Endoscopic full-thickness resection (eFTR) is a minimally invasive resection technique that allows definite diagnosis and treatment for complex colorectal lesions ≤ 30 mm unsuitable for conventional endoscopic resection. This study reports clinical outcomes from the Dutch colorectal eFTR registry. 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), re-resection 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 23 mm. 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. Thieme. All rights reserved.
Authors: Kim M Gijsbers; Lisa van der Schee; Tessa van Veen; Annemarie M van Berkel; Femke Boersma; Carolien M Bronkhorst; Paul D Didden; Krijn J C Haasnoot; Anne M Jonker; Koen Kessels; Nikki Knijn; Ineke van Lijnschoten; Clinton Mijnals; Anya N Milne; Freek C P Moll; Ruud W M Schrauwen; Ramon-Michel Schreuder; Tom J Seerden; Marcel B W M Spanier; Jochim S Terhaar Sive Droste; Emma Witteveen; Wouter H de Vos Tot Nederveen Cappel; Frank P Vleggaar; Miangela M Laclé; Frank Ter Borg; Leon M G Moons Journal: Endosc Int Open Date: 2022-04-14