RT Journal Article
SR Electronic
T1 Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 1280
OP 1289
DO 10.1136/gutjnl-2016-313677
VO 67
IS 7
A1 Arthur Schmidt
A1 Torsten Beyna
A1 Brigitte Schumacher
A1 Alexander Meining
A1 Hans-Juergen Richter-Schrag
A1 Helmut Messmann
A1 Horst Neuhaus
A1 David Albers
A1 Michael Birk
A1 Robert Thimme
A1 Andreas Probst
A1 Martin Faehndrich
A1 Thomas Frieling
A1 Martin Goetz
A1 Bettina Riecken
A1 Karel Caca
YR 2018
UL http://gut.bmj.com/content/67/7/1280.abstract
AB Objective Endoscopic full-thickness resection (EFTR) is a novel treatment of colorectal lesions not amenable to conventional endoscopic resection. The aim of this prospective multicentre study was to assess the efficacy and safety of the full-thickness resection device.Design 181 patients were recruited in 9 centres with the indication of difficult adenomas (non-lifting and/or at difficult locations), early cancers and subepithelial tumours (SET). Primary endpoint was complete en bloc and R0 resection.Results EFTR was technically successful in 89.5%, R0 resection rate was 76.9%. In 127 patients with difficult adenomas and benign histology, R0 resection rate was 77.7%. In 14 cases, lesions harboured unsuspected cancer, another 15 lesions were primarily known as cancers. Of these 29 cases, R0 resection was achieved in 72.4%; 8 further cases had deep submucosal infiltration >1000 µm. Therefore, curative resection could only be achieved in 13/29 (44.8%). In the subgroup with SET (n=23), R0 resection rate was 87.0%. In general, R0 resection rate was higher with lesions ≤2 cm vs >2 cm (81.2% vs 58.1%, p=0.0038). Adverse event rate was 9.9% with a 2.2% rate of emergency surgery. Three-month follow-up was available from 154 cases and recurrent/residual tumour was evident in 15.3%.Conclusion EFTR has a reasonable technical efficacy especially in lesions ≤2 cm with acceptable complication rates. Curative resection rate for early cancers was too low to recommend its primary use in this indication. Further comparative studies have to show the clinical value and long-term outcome of EFTR in benign colorectal lesions.Trial registration number NCT02362126; Results.