Systematic review and meta-analysis on effectiveness and safety of the full-thickness resection device (FTRD) in the colon

Abstract

Background Endoscopic full-thickness resection (EFTR) has expanded the possibilities of endoscopic resection. The full-thickness resection device (FTRD, Ovesco Endoscopy, Tübingen, Germany) combines a clip-based defect closure and snare resection in a single device.

Methods Systematic review and meta-analysis on effectiveness and safety of the FTRD in the colon.

Results A total of 26 studies (12 published as full-text articles and 14 conference papers) with 1538 FTRD procedures were included. The pooled estimate for reaching the target lesion was 96.1 % (95 % confidence interval [95 % CI]: 94.6–97.1) and 90.0 % (95 % CI: 87.0–92.3) for technically successful resection. Pooled estimate of histologically complete resection was 77.8 % (95 % CI: 74.7–80.6). Adverse events occurred at a pooled estimate rate of 8.0 % (95 % CI: 5.8–10.4). Pooled estimates for bleeding and perforation were 1.5 % (95 % CI: 0.3–3.3) and 0.3 % (95 % CI: 0.0–0.9), respectively. The rate for need of emergency surgery after FTRD was 1.0 % (95 % CI: 0.4–1.8).

Conclusion The use of the FTRD in the colon shows very high rates of technical success and complete resection (R0) as well as a low risk of adverse events. Emergency surgery after colonic FTRD resection is necessary in single cases only.

Zusammenfassung

Hintergrund Die endoskopische Vollwandresektion erweitert die Möglichkeiten endoskopischer Resektionen. Sie basiert auf der Resektion der Läsion einerseits und dem sicheren Verschluss des Resektionsdefekts andererseits. Das Full-Thickness Resection Device (FTRD, Ovesco Endoscopy, Tübingen) vereint beide Schritte in einem Gerät. Typische Indikationen sind sogenannte schwierige oder Non-lifting-Adenome im Kolon.

Methodik Systematisches Review und Metaanalyse zur Effektivität und Sicherheit der endoskopischen Vollwandresektion im Kolon mit dem FTRD-System.

Ergebnisse Insgesamt wurden 26 Studien eingeschlossen, darunter 12 Volltextpublikationen und 14 Kongressbeiträge. Die Gesamtzahl der analysierten FTRD-Prozeduren betrug 1538. Die Zielläsion wurde mit einer Rate von 96,1 % (95 %-Konfidenzintervall (95 %-KI): 94,6–97,1) erreicht. Die Resektion war in 90,0 % (95 %-KI: 87,0–92,3) technisch erfolgreich. und eine R0-Resektion gelang mit einer Rate von 77,8 % (95 %-KI: 74,7–80,6). Komplikationen traten bei 8,0 % (95 %-KI: 5,8–10,4) der Prozeduren auf; die Rate der Nachblutungen und Perforationen lag bei 1,5 % (95 %-KI: 0,3–3,3) bzw. 0,3 % (95 %-KI: 0,0–0,9). Die Rate komplikationsbedingter Operationen betrug 1,0 % (95 %-KI: 0,4–1,8).

Schlussfolgerung Die endoskopische Vollwandresektion im Kolon mittels FTRD ist effektiv und sicher. Eine R0-Resektion gelingt in vielen Fällen, und insbesondere schwerwiegende Komplikationen mit der Notwendigkeit einer Notfalloperation sind sehr selten.

Key words

endoscopic full-thickness resection (EFTR) - full-thickness resection device (FTRD) - non-lifting adenoma - colorectal cancer - colonoscopy - polypectomy

Schlüsselwörter

Vollwandresektion - FTRD - Adenom - Kolonkarzinom - Koloskopie - Polypektomie

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