Abstract
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.
