EFTR of duodenal lesions in 20 patients showed technical success in 17/20 (85.0 %), a R0 resection rate of 12/17 (70.6 %) and only minor peri-procedural bleeding in 3/20 cases (15.0 %). No major bleedings or perforations occurred.
Bauder M et al., Department of Gastroenterology and Oncology, Ludwigsburg Hospital, Ludwigsburg, Germany, performed a study investigating the safety and efficacy of FTRD application in the duodenum. Between 03/2014 and 06/2017, a total of 20 patients underwent EFTR of a duodenal lesion. Indication for EFTR was: adenomas (n=13, seven treatments naïve, six pretreated), subepithelial tumors (n=5) and T1 adenocarcinoma (n=1). The FTRD could be advanced to the lesion in 19/20 cases (95 %). In one case advancing the FTRD through the pylorus was not possible despite balloon dilatation. Overall technical success was 17/20 (85.0 %). In two cases the FTRD clip was deployed correctly, but the integrated snare could not be closed because of device dysfunction. Both lesions were then resected with a standard snare above the FTRD clip after extraction of the device. In both cases there was no macroscopic evidence of residual adenoma. However, R0 resection could not be confirmed in both cases. R0 resection rate in the technically successful FTRD applications was 12/17 (70.6 %). Minor bleedings occurred at the first post-interventional day in 3/20 patients (15.0 %). No major bleedings or perforations occurred. During follow-up after 3 and 12 months, there were two recurrent adenomas that were successfully re-resected by FTRD.
The authors concluded that the FTRD indicates good technical efficacy and safety for resection of duodenal non-ampullary adenomas and subepithelial tumors. It offers the possibility of re-resections at the same site. Especially in pretreated or difficult lesions, such as non-lifting adenomas, EFTR should be considered.
Endoscopic full-thickness resection of duodenal lesions-a retrospective analysis of 20 FTRD cases.
Bauder M, Schmidt A, Caca K.
United European Gastroenterol J 2018 Aug;6(7):1015-1021.