SAFETY AND FEASIBILITY OF ENDOSCOPIC FULL-THICKNESS RESECTION IN COLORECTUM USING OVER THE SCOPE CLIP. A MULTICENTER SPANISH EXPERIENCE 2015 – 2018

H Uchima; D Barquero; JM Esteban; JC Espinos; JC Marín Gabriel; P Rosón; F Fernandez Cadenas; A Ortega; M López Fraile; L Mel; MA Palacio Galán; I Puig; J Rodríguez-Sánchez; J Arribas; A Fernández Simón; F Sábado; J García Lledó; E Albéniz; A Mata

doi:10.1055/s-0039-1681573

Endoscopy, Table of Contents

Endoscopy 2019; 51(04): S137
DOI: 10.1055/s-0039-1681573

ESGE Days 2019 ePoster podium presentations

Friday, April 5, 2019 13:00 – 13:30: Colon: resection 1 ePoster Podium 2

Georg Thieme Verlag KG Stuttgart · New York

SAFETY AND FEASIBILITY OF ENDOSCOPIC FULL-THICKNESS RESECTION IN COLORECTUM USING OVER THE SCOPE CLIP. A MULTICENTER SPANISH EXPERIENCE 2015 – 2018

Authors

H Uchima

¹Gastrointestinal Endoscopy, Hospital Universitario Doctor Josep Trueta de Girona, Girona, Spain

²Gastrointestinal Endoscopy, Centro Medico Teknon, Barcelona, Spain
D Barquero

³Hospital Sant Joan Despi-Moises Broggi, Barcelona, Spain
JM Esteban

⁴Hospital Clinico San Carlos, Madrid, Spain
JC Espinos

²Gastrointestinal Endoscopy, Centro Medico Teknon, Barcelona, Spain

⁵Hospital Mutua Terrassa, Terrassa, Spain
JC Marín Gabriel

⁶Gastroenterology, Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
P Rosón

⁷Hospital Quiron Salud Malaga, Málaga, Spain
F Fernandez Cadenas

⁸Hospital Universitario Central de Asturias, Oviedo, Spain
A Ortega

⁷Hospital Quiron Salud Malaga, Málaga, Spain
M López Fraile

⁸Hospital Universitario Central de Asturias, Oviedo, Spain
L Mel

⁴Hospital Clinico San Carlos, Madrid, Spain
MA Palacio Galán

⁸Hospital Universitario Central de Asturias, Oviedo, Spain
I Puig

⁹Althaia, Xarxa Assistencial Universitària de Manresa, Digestive System Service, Manresa, Spain
J Rodríguez-Sánchez

¹⁰Gastrointestinal Endoscopy, Hospital General Universitario Ciudad Real, Ciudad Real, Spain
J Arribas

⁶Gastroenterology, Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
A Fernández Simón

³Hospital Sant Joan Despi-Moises Broggi, Barcelona, Spain
F Sábado

¹¹Consorcio Hospitalario Provincial Castellón, Castellón, Spain
J García Lledó

¹²Hospital Universitario Gregorio Marañón, Madrid, Spain
E Albéniz

¹³Complejo Hospitalario de Navarra, Digestive System Service, Endoscopy Unit, Pamplona, Spain
A Mata

²Gastrointestinal Endoscopy, Centro Medico Teknon, Barcelona, Spain

³Hospital Sant Joan Despi-Moises Broggi, Barcelona, Spain

Abstract

Full Text

Aims:

To study the safety and feasibility of the endoscopic full-thickness resection (EFTR) in colorectal lesions using an over-the-scope-clip.

Methods:

The clinical, endoscopic and histological data were collected prospectively in all cases of EFTR performed in 10 centers of Spain using the FTRD kit (Ovesco Endoscopy, Tübingen, Germany) during the period from June 2015 to July 2018.

Results:

71 EFTR were scheduled.

In 3 patients EFTR was not possible due to impossibility to pass the sigmoid with the kit.

In the other 68 patients the technical success was 85.2% with en-bloc resection in 83,8%.

The mean age of the patients was 67 years (range 40 – 86), being men 64,79%.

Indications were: non-lifting sign recurrent lesions (46.47%), non-lifting sign untreated lesions (23.94%), incomplete resection of non-lifting sign lesions (11,26%), appendicular lesions (2.8%), suspected T1 lesion (7%), EFTR of suspicious scar (4,2%), subepithelial lesions (4.2%).

The mean diameter of the resected specimen was 21.53 mm (95% CI 19.87 – 23,2).

Final histology: LGD adenoma (40%), HGD adenoma (23%), intramucosal adenocarcinoma (4.47%), SSP (5.87%), T1sm1 (2.9%), advanced adenocarcinoma >sm2 (13%), scar tissue (6%) and others (2.8%).

In one case the OTSC was not deployed, with intraprocedural perforation. There were 2 cases of delayed perforation and 1 case of delayed bleeding.

10 patients underwent surgery: 3 perforation, 1 intraapendicular lesion, and 6 for advanced adenocarcinoma.

During the follow-up, 3 recurrences/residual tissues were detected, which were treated endoscopically.

Conclusions:

EFTR using a modified OTSC (FTRD system) for selected cases (such as failure of other endoscopic treatments in lesions < 25 mm) is a safe and feasible technique.

Evaluation of the insertion with a long cap (e.g. "prOVE" cap) and traction of the lesion prior to EFTR is highly recommended. Special care must be taken to avoid performing the resection if the OTSC is not deployed.