Endoscopic treatment of a large non-lifting lesion with advanced histology by hybrid EFTR: A case report

We present the case of a 81 year old woman, frail but with no major comorbidity. In the context of a surveillance colonoscopy, a 45 mm granular LST with a central depressed area of 15 mm (0-IIa+IIc), JNET 2B, located in the cecum, was identified. The patient refused a surgical approach so endoscopic treatment was offered. Given the size of the lesion, it was not suitable to be resected en bloc by EFTR, and because of its characteristics and location, we decided not to perform an ESD considering the risk of perforation [1] [2] [3].

We performed a hybrid technique in which we resected by classic and underwater EMR the periphery of the lesion, with a 15 mm polypectomy snare, isolating the central depressed area, which was non-lifting, and therefore was resected using a FRTD kit (Ovesco ^R). Histological analysis revealed an colorrectal adenoma with high grade dysplasia and a minimal focus of invasive carcinoma (< 1 mm), confined to the piece resected by EFTR with a negative vertical margin of 5 mm and with no other factors of poor prognosis.

Hybrid EFTR is a safe and effective technique that has been proposed for the treatment of large non lifting lesions that can’t be adequately treated both by EMR o EFTR alone. In this case, the resection of the depressed area with a full-thickness device, allowed us to isolate the fragment with invasive carcinoma and confirm that no other factors of poor prognosis were present.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Mahadev S, Vareedayah AA, Yuen S. et al. Outcomes of a hybrid technique using EMR and endoscopic full-thickness resection for polyps not amenable to standard techniques (with video). Gastrointest Endosc 2021; 94: 358-67
• 2 Meier B, Elsayed I, Seitz N. et al. Efficacy and safety of combined EMR and endoscopic full-thickness resection (hybrid EFTR) for large nonlifting colorectal adenomas. Gastrointest Endosc 2023; 98: 405-11
• 3 Zwager LW, Mueller J, Stritzke B. et al. Adverse events of endoscopic full-thickness resection: results from the German and Dutch nationwide colorectal FTRD registry. Gastrointest Endosc 2023; 97: 780-9.e4