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Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety

Background and study aims  Endoscopic full-thickness resection (eFTR) allows en-bloc and transmural resection of colorectal lesions for which other advanced endoscopic techniques are unsuitable. We present our experience with a novel “clip first, cut later” eFTR-device and evaluate its indications,...

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Autores principales: van der Spek, Bas, Haasnoot, Krijn, Meischl, Christof, Heine, Dimitri
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2018
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175680/
https://www.ncbi.nlm.nih.gov/pubmed/30302380
http://dx.doi.org/10.1055/a-0672-1138
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author van der Spek, Bas
Haasnoot, Krijn
Meischl, Christof
Heine, Dimitri
author_facet van der Spek, Bas
Haasnoot, Krijn
Meischl, Christof
Heine, Dimitri
author_sort van der Spek, Bas
collection PubMed
description Background and study aims  Endoscopic full-thickness resection (eFTR) allows en-bloc and transmural resection of colorectal lesions for which other advanced endoscopic techniques are unsuitable. We present our experience with a novel “clip first, cut later” eFTR-device and evaluate its indications, efficacy and safety. Patients and methods  From July 2015 through October 2017, 51 eFTR-procedures were performed in 48 patients. Technical success and R0-resection rates were prospectively recorded and retrospectively analyzed. Results  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 %). Histopathology confirmed full-thickness resection in 43 of 50 specimens (86 %) and radical resection (R0) in 40 procedures (80 %). 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. One perforation occurred, which was corrected endoscopically. No emergency surgery was necessary. Conclusion  In this study eFTR appears to be safe and effective for the resection of colorectal lesions. Technical success, R0-resection and major adverse events rate were reasonable and comparable with eFTR data reported elsewhere. Mean specimen diameter (23 mm) limits its use to relatively small lesions. A clinical algorithm for eFTR case selection is proposed. eFTR ensured local radical excision where other endoscopic techniques did not suffice and reduced the need for surgery in selected cases.
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spelling pubmed-61756802018-10-09 Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety van der Spek, Bas Haasnoot, Krijn Meischl, Christof Heine, Dimitri Endosc Int Open Background and study aims  Endoscopic full-thickness resection (eFTR) allows en-bloc and transmural resection of colorectal lesions for which other advanced endoscopic techniques are unsuitable. We present our experience with a novel “clip first, cut later” eFTR-device and evaluate its indications, efficacy and safety. Patients and methods  From July 2015 through October 2017, 51 eFTR-procedures were performed in 48 patients. Technical success and R0-resection rates were prospectively recorded and retrospectively analyzed. Results  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 %). Histopathology confirmed full-thickness resection in 43 of 50 specimens (86 %) and radical resection (R0) in 40 procedures (80 %). 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. One perforation occurred, which was corrected endoscopically. No emergency surgery was necessary. Conclusion  In this study eFTR appears to be safe and effective for the resection of colorectal lesions. Technical success, R0-resection and major adverse events rate were reasonable and comparable with eFTR data reported elsewhere. Mean specimen diameter (23 mm) limits its use to relatively small lesions. A clinical algorithm for eFTR case selection is proposed. eFTR ensured local radical excision where other endoscopic techniques did not suffice and reduced the need for surgery in selected cases. © Georg Thieme Verlag KG 2018-10 2018-10-08 /pmc/articles/PMC6175680/ /pubmed/30302380 http://dx.doi.org/10.1055/a-0672-1138 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle van der Spek, Bas
Haasnoot, Krijn
Meischl, Christof
Heine, Dimitri
Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety
title Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety
title_full Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety
title_fullStr Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety
title_full_unstemmed Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety
title_short Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety
title_sort endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175680/
https://www.ncbi.nlm.nih.gov/pubmed/30302380
http://dx.doi.org/10.1055/a-0672-1138
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