Introduction Introduction of the English Bowel Cancer Screening Program has resulted in increase in the number of patients diagnosed with endoscopically irresectable colonic polyps. A significant proportion of these patients undergo hemicolectomy associated with a significant risk of death, anastomotic leakage and general complications. The need for an alternative, less invasive treatment option for this patient cohort is becoming increasingly clear.
Methods Systematic literature searches identified articles describing EFTR in the colon of adult pigs, published 1990–2012. Complication rates, anastomotic bursting pressures, procedure duration, specimen size and quality, and post-mortem findings were analysed.
Results Four EFTR techniques using endoscopic stapling devices, T-tags, compression closure or laparoscopic assistance for defect closure before or after specimen resection were reported. 113 procedures were performed in 99 porcine models (Table 1), with an overall success rate of 89% and a 4% mortality. The intraoperative complication rate was 22% (0% > 67%).Post-resection closure methods (as opposed to simultaneous resection and closure) more commonly resulted in failure to close the defect (5% > 55%) and a high incidence of abnormal findings at post-mortem examination (84%). Significant heterogeneity was observed in procedure duration (average 3 min to 233 min) and size of the excised specimen (average 1.7 cm to 3.6 cm). Anastomotic bursting pressures and specimen quality were poorly documented.
Conclusion The technique of EFTR is in development, with experience currently limited to preclinical studies. The inability to close the resection defect reliably is the primary obstacle to further progress. This review highlights the challenges that need to be addressed in future preclinical studies.
Disclosure of Interest None Declared
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