Introduction We have the largest UK experience (17 cases) with the novel endoscopic full thickness resection device (FTRD), which allows endoscopic resection of non-lifting adenomas, subepithelial tumours, and T1 cancers. Here we report and demonstrate the use of a Hybrid resection technique that combines traditional EMR with endoscopic full thickness resection (eFTR) for large scarred polyps where traditionally surgery would be required.
Method In our series of endoscopic full thickness resections (eFTR) from April 2015 – February 2017, 4 scarred polyps were too large for traditional eFTR with a diameter larger than the limit of the FTRD device of around 30 mm. These patients were assessed as high risk for surgery, but had good life expectancy and wanted the polyp to be removed. We developed a strategy of resecting the polyps in 2 stages. Stage 1 involved traditional EMR of the non-scarred/lifting segment of the polyp. Stage 2 involved resecting the remaining scarred part of the polyp with eFTR. Outcomes were success of eradication of polyp and adverse events.
Results All 4 cases underwent the hybrid eFTR resection. Median size of referred polyp was 50 mm (30–60 mm), 2 were laterally spreading tumour (LST) non-granular type with Paris classification 0-2a/b and 2 were LST granular type 0-1s+2 a/b. All cases initially underwent traditional EMR with a median procedural time of 90 min (60–130 min). 3 months later eFTR took place successfully in all 4 patients; median procedural time 56.5mins (41-71mins), and median specimen size 22.5 mm (18–25 mm). Histology confirmed full thickness resection in all 4 cases, and R0 resection in 2/4. 3 month follow up is complete in all 4 cases; 2 mm residual adenoma was found in 1 patient and treated by biopsy and argon therapy to scar with site clear of adenoma at 1 year follow up. In all cases, the polyp was eradicated with no adverse events, including no post procedural complications of bleeding or perforation. The video illustrates the technique used in a patient referred with an extensive and heavily scarred polyp (60 mm LST-G, 0-1s+2 a/b).
Conclusion Hybrid eFTR of large scarred colonic polyps is a feasible alternate to surgery in selected cases with good outcomes and favourable safety profile.
Disclosure of Interest None Declared
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