Endoscopy 2020; 52(11): 1014-1023
DOI: 10.1055/a-1176-1107
Original article

Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

Liselotte W. Zwager*
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
,
Barbara A. J. Bastiaansen*
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
,
Maxime E. S. Bronzwaer
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
,
Bas W. van der Spek
 2   Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, The Netherlands
,
G. Dimitri N. Heine
 2   Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, The Netherlands
,
Krijn J. C. Haasnoot
 3   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Hedwig van der Sluis
 4   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
,
Lars E. Perk
 5   Department of Gastroenterology and Hepatology, Haaglanden Medical Center, The Hague, The Netherlands
,
Jurjen J. Boonstra
 6   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
,
Svend T. Rietdijk
 7   Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
,
Hugo J. Wolters
 8   Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, The Netherlands
,
Bas L. A. M. Weusten
 9   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Lennard P. L. Gilissen
10   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
,
W. Rogier ten Hove
11   Department of Gastroenterology and Hepatology, Alrijne Medical Group, Leiden, The Netherlands
,
Wouter B. Nagengast
12   Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
,
Frank C. Bekkering
13   Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
,
M. P. Schwartz
14   Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
,
Jochim S. Terhaar sive Droste
15   Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
,
Marije S. Vlug
16   Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, The Netherlands
,
Martin H. M. G. Houben
17   Department of Gastroenterology and Hepatology, Haga Teaching Hospital, The Hague, The Netherlands
,
Francisco J. Rando Munoz
18   Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, The Netherlands
,
Tom C. J. Seerden
19   Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
,
Hanneke Beaumont
20   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU, Amsterdam, The Netherlands
,
Rogier de Ridder
21   Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Evelien Dekker
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
,
Paul Fockens
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
,
on behalf of the Dutch eFTR Group › Author Affiliations
Trial Registration: Dutch Trial Register Registration number (trial ID): NTR6292 Type of study: Prospective study

Abstract

Background Endoscopic full-thickness resection (eFTR) is a minimally invasive resection technique that allows definite diagnosis and treatment for complex colorectal lesions ≤ 30 mm unsuitable for conventional endoscopic resection. This study reports clinical outcomes from the Dutch colorectal eFTR registry.

Methods Consecutive patients undergoing eFTR in 20 hospitals were prospectively included. The primary outcome was technical success, defined as macroscopic complete en bloc resection. Secondary outcomes were: clinical success, defined as tumor-free resection margins (R0 resection); full-thickness resection rate; and adverse events.

Results Between July 2015 and October 2018, 367 procedures were included. Indications were difficult polyps (non-lifting sign and/or difficult location; n = 133), primary resection of suspected T1 colorectal cancer (CRC; n = 71), re-resection after incomplete resection of T1 CRC (n = 150), and subepithelial tumors (n = 13). Technical success was achieved in 308 procedures (83.9 %). In 21 procedures (5.7 %), eFTR was not performed because the lesion could not be reached or retracted into the cap. In the remaining 346 procedures, R0 resection was achieved in 285 (82.4 %) and full-thickness resection in 288 (83.2 %). The median diameter of resected specimens was 23 mm. Overall adverse event rate was 9.3 % (n = 34/367): 10 patients (2.7 %) required emergency surgery for five delayed and two immediate perforations and three cases of appendicitis.

Conclusion eFTR is an effective and relatively safe en bloc resection technique for complex colorectal lesions with the potential to avoid surgery. Further studies assessing the role of eFTR in early CRC treatment with long-term outcomes are needed.

* Contributed equally to this article


Supplementary material



Publication History

Received: 03 February 2020

Accepted: 22 April 2020

Publication Date:
04 June 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany