ENDOSCOPIC FULL-THICKNESS RESECTION FOR THE MANAGEMENT OF DIFFICULT COLORECTAL LESIONS: A PROSPECTIVE COHORT STUDY

Aims The aim of this study is to evaluate the safety and efficacy of endoscopic full-thickness resection for the management of difficult colonic lesions.

Methods Prospective cohort study of sequential patients referred to two tertiary referral centers for management of difficult colonic lesions. We used descriptive analysis, Student’s t-test, Wilcoxon sum rank test and Chi square tests as appropriate.

Results We included 20 patients from two tertiary referral centers (70% male; median age 71.5 years, inter-quartile range [IQR] 65.5–80.0). About half of patient had cardiovascular comorbidities and 15% were receiving antiaggregants other than low-dose aspirin or anticoagulant therapy at the time of procedure. Indications for full-thickness resection included malignant histology or malignant appearing pit-pattern (40%), recurrence of lesions after previous endoscopic resection/surgery or non-lifting sign (50%), and intradiverticular or intrappendicular location (10%). The lesions were located at the rectum (25%), sigmoid (15%), descending colon (15%), ascending colon (20%), cecum (20%) and surgical anastomosis (5%). The lesions had a mean size of 19 mm (range 9–40 mm). The technical success of the full thickness procedure was 95% (in one case the procedure was not feasible because of difficult location), and lasted for a median 15 minutes (IQR 15–20). There were no immediate peri-procedural complications. Of those who were hospitalized, all but one patient (94%) were discharged on the successive day. During a median follow-up of 5 months (IQR 0–17 months), there was one severe complication, consisting of acute appendicitis requiring surgery. During follow-up we observed recurrences in two patients (17%), both small (< 10 mm) adenomatous recurrence about 6 months after the procedure, that were removed with biopsy forceps and/or argon plasma coagulation.

Conclusions Endoscopic full-thickness resection is a safe and effective method of treating malignant or difficult colonic lesions. Larger prospective studies are needed to confirm these results.