Endoscopic full-thickness resection (EFTR) implementation in a single center: indications and outcomes in the first 35 cases

Aims Endoscopic full-thickness resection (EFTR) is a minimally invasive resection technique for epithelial and subepithelial lesions of the lower and upper gastrointestinal tract. It reduces procedure-related complications and mortality. The aim of this study is to report the results of all EFTRs performed at a single centre in Slovenia.

Methods Endoscopic full-thickness resection was introduced in our unit in June 2022. All consecutive patients were included in prospectively managed endoscopic EFTR registry. Data were extracted from the registry and analysed retrospectively. Endpoints of the study were: technical success, R0-resection, adverse events and rate of surgery (medical indication and EFTR related complication).

Results Between June 2022 and June 2024, a total of 35 lesions in 34 patients were removed with EFTR in our unit. Technical success was achieved in 30 (85.7%) cases. The majority of cases were performed in the colon 32 (91.4%). The most common indication was pT1 colorectal cancer 13 (37.1%), followed by periapendicular location 9 (25.7%) and severe fibrosis in the polyp 7 (20%). The median specimen size was 13 mm (5 – 25 mm). The most common anatomical location was appendix 9 (25.7%), followed by the ascending colon 7 (20%) and the sigmoid colon 6 (17.1%). More than half of the patients 24 (68.6%) were performed in an inpatient setting. R0 resection was achieved in 23 cases (65.7%). The most common pathohistological finding was low-grade dysplasia in tubular adenoma 8 (22.8%). There were five severe adverse events (14.3%), the most common of which was appendicitis 3 (8.6%), sigmoid perforation for a lesion in the right hemicolon and the ascending colon perforation after EFTR and clip malfunction. In this case the perforation was successfully closed with the TTS clips. A total of 16 patients (45.7%) underwent surgery, 4 of which were for EFTR related complication (11.4%). More than half of the periappendiceal lesions 6/9 (66%) underwent surgery, of which half were due to appendicitis and the other half after the R1 resection.

Conclusions In conclusion, our early experience with EFTR demonstrates its potential as a minimally invasive option for treating a variety of gastrointestinal lesions. While the procedure proved effective in most cases, appendiceal lesions presented significant challenges, with a high rate of adverse events such as appendicitis and a substantial need for subsequent surgical intervention. In fact, two-thirds of the patients with periappendiceal lesions required surgery, underscoring the difficulty of achieving both safe and complete resection in this location.

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Artikel online veröffentlicht:
27. März 2025