Prospective data from 51 FTRD-procedures shows technical success in 88 % (45/51) and a R0-resection rate of 89 % (40/45). EFTR-specimens, obtained for indeterminate previous T1 colorectal carcinoma resection, were free of residual carcinoma in 25 of 26 cases (96 %)
Van der Spek B et al., Department of Gastroenterology and Hepatology, Northwest Hospital group, Alkmaar, The Netherlands, published a single-center case series evaluating resection of colorectal lesions with the FTRD device.
Between 07/2015 and 10/2017, 51 EFTR procedures were performed in 48 patients (63 % men, median age 69). Indications for EFTR were non-lifting adenoma (n = 19), primary resection of malignant lesion (n = 2), resection of scar tissue after incomplete endoscopic resection of low-risk T1 colorectal carcinoma (n = 26), adenoma involving a diverticulum (n = 2) and neuroendocrine tumor (n = 2). Two lesions were treated by combining endoscopic mucosal resection and EFTR. Technical success was achieved in 45 of 51 procedures (88 %). Five resections were macroscopically incomplete and in one case no specimen could be obtained due to inability to mobilize the lesion into the cap. Mean estimated lesion size was 12.2 mm (range 2 – 30). Mean maximum resection specimen diameter was 23 mm (range 11 – 45). Histopathology confirmed full-thickness resection in 43 of the remaining 45 specimens (96 %) and radical resection (R0) in 40/45 procedures (89 %). EFTR-specimens, obtained for indeterminate previous T1 colorectal carcinoma resection, were free of residual carcinoma in 25 of 26 cases (96 %). In six patients (13 %) a total of eight adverse events occurred within 30 days after EFTR. Four of these patients had minor bleeding not necessitating blood transfusion. One patient suffered major bleeding needing blood transfusion. One perforation occurred, which was corrected endoscopically. No emergency surgery was necessary. Six patients needed additional surgery because of either high risk for lymph node metastases (n = 4; three patients with T2-T3 CRC and one patient with lymphatic invasion in T1 CRC), technical failure of EFTR (n = 1) or endoscopically untreatable adenoma recurrence at surveillance (n = 1).
The authors concluded that this study confirmed safety and efficacy of the FTRD device for the resection of colorectal lesions. They proposed a clinical algorithm for EFTR case selection. EFTR allows en-bloc and transmural resection where other advanced endoscopic techniques are unsuitable and reduces the need for surgery in selected cases.
Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety
Van der Spek B, Haasnoot K, Meischl C, Heine D
Endoscopy International Open 2018; 06:E1227-E1234