Introduction Colectomy for complex colonic polyps and early colonic cancer has increased due to national bowel cancer screening programs. However, traditional radical colonic resection risks substantial morbidity and alternative approaches are required. This review summarises the published methods of colonic endoscopic full-thickness resection (EFTR), examining data on feasibility and safety.
Method Systematic literature searches identified articles describing EFTR techniques of colon, published between 1990 and 2015 in both experimental and clinical studies. Feasibility and safety were the primary outcomes.
Results Preclinical research reported on three EFTR techniques using endoscopic stapling devices, T-tags or compression device closure for defect closure before (pre-resection) or after specimen resection (post-resection). A total of 103 procedures were performed in 99 porcine models, with an overall success rate of 87% (90/103 procedures). The intraoperative complication rate was 19% (17/90 procedures). Post-resection closure methods more commonly resulted in failure to close the defect and a high incidence of abnormal findings at post-mortem examination. Five clinical studies reported EFTR in 38 patients, with three studies using a compression device for pre-resection closure and one study reporting a post-resection closure technique. EFTR was completed in 33/38 patients without assistance. Only three patients had reported complications. Lateral margin clearance was variably reported and complete full-thickness resection was achieved in only 12/17 patients.
Conclusion The technique of EFTR is evolving, with only limited clinical evidence to date, but currently pre-resection closure methods should be advocated. Significant technological challenges remain before colonic EFTR can be recommended in clinical practice, including reproducible lateral margin clearance.
Disclosure of interest None Declared.
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