Hybrid EMR-FTRD®: In large colorectal lesions with non-lifting areas this hybridtechnique can close the therapeutic gap and avoid surgery

A retrospective cohort study of 17 patients undergoing hybrid EMR-FTRD for large colorectal lesions showed 100 % technical success and 76.4 % histologically confirmed R0-resection. No perforation or major bleeding occurred. Follow-up endoscopy showed recurrent adenomas in 2 patients.

M. Bauermeister et al., Sana Klinikum Lichtenberg, Berlin, Germany performed a retrospective evaluation of 17 patients undergoing hybrid EMR-FTRD for large colorectal lesions with non-lifting signs. Endpoints of the study were technical success, histological confirmation of R0-resection and adverse events.

All seventeen lesions were too large for en-bloc resection with the FTRD and all had positive lateral lifting signs. Therefore, a hybrid approach combining piecemeal EMR with FTRD was performed. After submucosal injection of saline and toluidine blue, the lateral parts of the adenoma were resected with piecemeal EMR. The non-lifting area of the adenoma was not touched. Afterwards, the FTRD was used for en-bloc resection of the remaining lesion. The specimen was retrieved and examined histologically. Endoscopy was finished by a final check of macroscopic success and exclusion of bleeding and perforation. A follow-up endoscopy was scheduled after 12 weeks for inspection including taking biopsies at the resection site.

Mean age of patients was 76 years (range 62-88 years). The lesions were located in the rectum (n=6), sigmoid colon (n=5), transverse colon (n=2), caecum (n=3), and at the appendiceal orifice (n=1). The average size of the lesions was 29 mm (range 20-50 mm). Mean procedural duration was 69 min (range 35-160 min).
Technical success was achieved in all patients. 94.1 % of lesions (16/17) could be resected macroscopically complete with confirmed full-thickness resection. Histological work-up of the specimens showed R0-resection in 13 patients (76.4 %), unclear margins in 2 patients (11.8 %) and positive margins in 2 patients (11.8 %).
No immediate severe adverse events such as perforation or major bleeding occurred. Follow-up endoscopic examination was available in 12 patients of which 10 were without recurrent adenoma. One patient showed a stenosis in the sigmoid colon after resection and one recurrent adenoma was detected in 2 out of the 12 patients in follow-up endoscopy.

The authors concluded that hybrid EMR-FTRD in the colorectum seems to be a safe and effective technique for large non-lifting lesions with positive lifting signs in the margins. This hybrid technique might close a therapeutic gap and thus avoid surgery. Further prospective evaluation of efficacy, safety and long-term outcome of this hybrid technique is necessary.

Hybrid resection of large colorectal adenomas combining EMR and FTRD
Bauermeister M, Mende M, Hornoff S, Faiss S.
Scandinavian Journal of Gastroenterology, DOI: 10.1080/00365521.2021.1933583

colonic FTRD® mounted on an endoscope enables endoscopic full-thickness resection of lesions in the colon and rectum Ovesco Endoscopy