ADVERSE EVENTS OF ENDOSCOPIC FULL-THICKNESS RESECTION: RESULTS FROM THE GERMAN AND DUTCH COLORECTAL EFTR REGISTRY

Aims Endoscopic full-thickness resection (eFTR) is emerging as minimally invasive alternative to surgery for complex colorectal lesions. Previous eFTR reports demonstrated favorable safety, however large studies representing a generalizable estimation of adverse events (AEs) are lacking. Our aim was to provide further insight in AEs following colorectal eFTR.

Methods This is an observational study of patients included in the German and Dutch colorectal eFTR registries between July 2015 and March 2021. All AEs were analysed.

Results In total 1894 procedures were included. Total AE rate was 11.1% (n=211/1894; 95% confidence interval (CI)[9.7–12.6%]). Perforations occurred in 2.5% (n=47/1894; 95%CI[1.8–3.3%]), 27 direct and 20 delayed. Successful endoscopic closure was performed in 34.0% (13 direct and 1 delayed) and antibiotic treatment only in 4.3% (2 delayed). Appendicitis rate for appendiceal lesions was 10.0% (n=13/130; 95%CI[5.4–16.5%]) and 46.2% (6/13) could be treated conservatively. Severe AE rate requiring emergency surgery was 2.3% (n=43/1894; 95%CI[1.7–3.0%]). These concerned delayed perforations in 0.9% (n=17/1894) and direct perforations in 0.7% (n=14/1894). Delayed perforations occurred between day 1-10 post-eFTR (median of 2 days). In total, 58.8% (10/17) was located in the left-sided colon. Other severe AEs were appendicitis in 0.4% (n=7/1894), stenosis in 0.1% (n=2/1894), delayed bleeding in 0.1% (n=1/1894), severe pain following eFTR close to dentate line 0.1% (n=1/1894) and entrapment of grasper in clip 0.1% (n=1/1894). No procedure-related mortality occurred.

Conclusions eFTR is a relative safe procedure with a low risk for severe AEs. Patients should be well informed on the risk of a delayed perforation and appendicitis.

Publication History

Article published online:
14 April 2022