EFTR with the FTRD® should be considered as an alternative to surgery in gastrointestinal lesions that are not amenable to conventional endoscopic resection

A meta-analysis comprising 18 studies with overall 730 patients with difficult gastrointestinal lesions showed a R0 resection rate of 82 %, a full-thickness resection rate of 83 %, and an enbloc resection rate of 95 %. The pooled estimate for perforation was < 0.1 % and for bleeding 2 %.

O. I. Brewer Gutierrez et al., Division of Gastroenterology and Hepatology, John Hopkins Hospital, Baltimore, Maryland, USA, published a meta-analysis aiming to summarize the current scientific evidence on efficacy, safety and clinical outcomes of patients with gastrointestinal neoplasia treated with the FTRD. The primary outcome of interest was the rate of histologically confirmed R0 resection, secondary outcomes were enbloc resection rate, rate of full thickness resection, adverse events, and post-EFTR surgery. The authors performed a comprehensive literature search and used the random-effects model to calculate pooled estimates and generate forest plots.

The meta-analysis included 18 studies with overall 730 patients and 733 lesions for analysis. Indications for EFTR were difficult residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice, and early cancer (n = 634), colorectal subepithelial lesions (n = 42), upper gastrointestinal lesions (n = 51), and other colonic lesions (n = 6). Median size of the lesions was 13.5 mm. 22 EFTR attempts failed. The pooled overall R0 resection rate was 82 % (95 % CI: 75 – 89). The pooled overall FTR rate was 83 % (95 % CI: 77 – 89). The pooled overall enbloc resection rate was 95 % (95 % CI: 92 – 96). The pooled estimates for perforation and bleeding were < 0.1 % and 2 %, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason (pooled rate 7 %, 95 % CI: 2 – 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4 %, < 0.1 %, and < 0.1 %, respectively. No mortality related to EFTR was observed.

The authors concluded that EFTR with the FTRD is safe and effective for difficult mucosal and submucosal gastrointestinal lesions with high rates of complete resection and an acceptable rate of adverse events. These findings emphasize the importance of optimizing and standardizing the EFTR technique, of attaining widespread implementation of this procedure and thereby sparing the need of surgery in patients with difficult mucosal and submucosal gastrointestinal lesions.

Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis
Brewer Gutierrez OI, Akshintala VS, Ichkhanian Y, Brewer GG, Hanada Y, Truskey MP, Agarwal A, Hajiyeva G, Kumbhari V, Kalloo AN, Khashab MA, Ngamruengphong S
Endosc Int Open. 2020 Mar;8(3):E313-E325. doi: 10.1055/a-1073-7593. Epub 2020 Feb 21.