EFTR is a useful tool for staging of early colorectal cancer and simultaneously can be sufficient treatment for low-risk lesions

In 156 patients with histologic evidence of adenocarcinoma, EFTR was technically successful in 92.3 % and R0 resection was achieved in 71.8 %. Exact risk stratification was possible in 99.3 %. Severe procedure-related adverse events were recorded in 3.9 % of patients.

A. Kuellmer et al., University Medical Center Freiburg, Germany, conducted a multicenter, retrospective study aiming to evaluate efficacy, safety and clinical value of EFTR for early colorectal cancer. Current international guidelines recommend endoscopic resection for T1 colorectal cancer with low-risk histology features and oncologic resection for those at high risk of lymphatic metastasis. Exact risk stratification is therefore crucial to avoid under-treatment as well as over-treatment.
Records of 1234 patients undergoing EFTR for various indications at 96 centers were screened for eligibility. A total of 156 patients with histologic evidence of adenocarcinoma were identified. This cohort included 64 cases undergoing EFTR after incomplete resection of a malignant polyp (group 1) and 92 non-lifting lesions (group 2).

Technical success was achieved in 144/156 patients (92.3 %). Mean procedural time was 42 minutes. R0 resection was achieved in 112/156 patients (71.8 %). A subgroup-analysis was performed assessing the R0 resection rate for subgroup 1 (previous incompletely resected malignant polyps, n=64) and subgroup 2 (non-lifting lesions, n=92). In group 1, a R0 resection rate of 87.5 % and in group 2 a R0 resection rate of 60.9 % had been reached (p<0.001).

Severe procedure-related adverse events (all perforations) were recorded in 6 cases (3.9 % of patients). One perforation was diagnosed immediately during the intervention and closed successfully with an over-the-scope clip. Five secondary perforations were observed after 1-8 days and required surgical intervention. Discrimination between high-risk versus low-risk tumor was successful in 155/156 cases (99.3 %). In group 1, 84.1 % were identified as low-risk lesions, whereas 16.3 % in group 2 had low-risk features. In total, 53 patients (34 %) underwent oncologic resection due to high-risk features. 98 patients (62 %) were followed endoscopically.

The authors concluded that in colorectal cancer, EFTR is technically feasible, effective and safe. It allows exact histological risk stratification and can avoid surgery for low-risk lesions. Prospective studies are required to further define indications for EFTR in malignant colorectal lesions and to evaluate long-term outcome.

Endoscopic full-thickness resection for early colorectal cancer.
Kuellmer A, Mueller J, Caca K, Aepli P, Albers D, Schumacher B, Glitsch A, Schaefer C, Wallstabe I, Hofmann C, Erhardt A, Meier B, Bettinger D, Thimme R, Schmidt A.
Gastrointest Endosc 2019; 89(6):1180-89.