ENDOSCOPIC FULL-THICKNESS RESECTION OF THE COLORECTAL LESIONS – A CZECH MULTICENTER EXPERIENCE

Aims:

The purpose of the analysis was to evaluate feasibility, efficacy and safety of endoscopic full-thickness resection (FTR) of the colorectal lesions performed in the Czech Republic.

Methods:

We prospectively evaluated patients treated with FTR in seven tertiary endoscopy centers in the Czech Republic performing FTR.

Results:

A total of 63 patients (mean age 68.3 ± 12.1 years, 79% males) have been treated since June 2016. Indication for FTR was local residual neoplasia in 32 (51%), non-lifting neoplasia in 19 (30%), periappendicular neoplasia in 8 (13%), subepithelial tumor in 2 (3%) and transmural rectal biopsy in 2 patients (3%). FTR was technically feasible in 89% (56/63). There were 5 cases of snare dysfunction and it was not possible to pull a lesion into the cap in 2 cases. Full-thickness resection was histologically confirmed in 79% (50/63). R0 resection was achieved in 85% (52/61) including resections with standard snare following FTR snare dysfunction. Resections were considered curative in 79% (48/61), 6 cases of cancer with deep submucosal invasion were referred for surgery. In curatively treated patients, there were 9 cases of sm¹ cancer, 3 cases of intramucosal cancer, 20 cases of high-grade dysplasia adenoma, 10 cases of low-grade dysplasia adenoma, 5 cases of completely resected scar and 1 case of granular tissue. Complications occurred in 13% (8/63). There were 2 cases of delayed perforation treated surgically, 2 cases of acute apendicitis responding to conservative treatment and 4 cases of delayed bleeding.

Conclusions:

In our series of 63 patients treated by FTR in the Czech Republic, we demonstrate high technical feasibility in 89%, R0 resection rate in 85% and curative resection rate in 79% of cases. Complications occured in 13% of patients, including two cases of delayed perforation requiring surgical therapy.