Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

Liselotte W. Zwager; Barbara A. J. Bastiaansen; Maxime E. S. Bronzwaer; Bas W. van der Spek; G. Dimitri N. Heine; Krijn J. C. Haasnoot; Hedwig van der Sluis; Lars E. Perk; Jurjen J. Boonstra; Svend T. Rietdijk; Hugo J. Wolters; Bas L. A. M. Weusten; Lennard P. L. Gilissen; W. Rogier ten Hove; Wouter B. Nagengast; Frank C. Bekkering; M. P. Schwartz; Jochim S. Terhaar sive Droste; Marije S. Vlug; Martin H. M. G. Houben; Francisco J. Rando Munoz; Tom C. J. Seerden; Hanneke Beaumont; Rogier de Ridder; Evelien Dekker; Paul Fockens; on behalf of the Dutch eFTR Group

doi:10.1055/a-1176-1107

Endoscopy, Inhaltsverzeichnis

Endoscopy 2020; 52(11): 1014-1023
DOI: 10.1055/a-1176-1107

Original article

Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

Liselotte W. Zwager‡^*

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands

,

Barbara A. J. Bastiaansen‡^*

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands

,

Maxime E. S. Bronzwaer

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands

,

Bas W. van der Spek

²Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, The Netherlands

,

G. Dimitri N. Heine

²Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, The Netherlands

,

Krijn J. C. Haasnoot

³Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Hedwig van der Sluis

⁴Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands

,

Lars E. Perk

⁵Department of Gastroenterology and Hepatology, Haaglanden Medical Center, The Hague, The Netherlands

,

Jurjen J. Boonstra

⁶Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands

,

Svend T. Rietdijk

⁷Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

,

Hugo J. Wolters

⁸Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, The Netherlands

,

Bas L. A. M. Weusten

⁹Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands

,

Lennard P. L. Gilissen

¹⁰Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands

,

W. Rogier ten Hove

¹¹Department of Gastroenterology and Hepatology, Alrijne Medical Group, Leiden, The Netherlands

,

Wouter B. Nagengast

¹²Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands

,

Frank C. Bekkering

¹³Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands

,

M. P. Schwartz

¹⁴Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands

,

Jochim S. Terhaar sive Droste

¹⁵Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands

,

Marije S. Vlug

¹⁶Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, The Netherlands

,

Martin H. M. G. Houben

¹⁷Department of Gastroenterology and Hepatology, Haga Teaching Hospital, The Hague, The Netherlands

,

Francisco J. Rando Munoz

¹⁸Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, The Netherlands

,

Tom C. J. Seerden

¹⁹Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands

,

Hanneke Beaumont

²⁰Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU, Amsterdam, The Netherlands

,

Rogier de Ridder

²¹Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands

,

Evelien Dekker

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands

,

Paul Fockens

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands

,

on behalf of the Dutch eFTR Group

› Institutsangaben

Abstract

Background Endoscopic full-thickness resection (eFTR) is a minimally invasive resection technique that allows definite diagnosis and treatment for complex colorectal lesions ≤ 30 mm unsuitable for conventional endoscopic resection. This study reports clinical outcomes from the Dutch colorectal eFTR registry.

Methods Consecutive patients undergoing eFTR in 20 hospitals were prospectively included. The primary outcome was technical success, defined as macroscopic complete en bloc resection. Secondary outcomes were: clinical success, defined as tumor-free resection margins (R0 resection); full-thickness resection rate; and adverse events.

Results Between July 2015 and October 2018, 367 procedures were included. Indications were difficult polyps (non-lifting sign and/or difficult location; n = 133), primary resection of suspected T1 colorectal cancer (CRC; n = 71), re-resection after incomplete resection of T1 CRC (n = 150), and subepithelial tumors (n = 13). Technical success was achieved in 308 procedures (83.9 %). In 21 procedures (5.7 %), eFTR was not performed because the lesion could not be reached or retracted into the cap. In the remaining 346 procedures, R0 resection was achieved in 285 (82.4 %) and full-thickness resection in 288 (83.2 %). The median diameter of resected specimens was 23 mm. Overall adverse event rate was 9.3 % (n = 34/367): 10 patients (2.7 %) required emergency surgery for five delayed and two immediate perforations and three cases of appendicitis.

Conclusion eFTR is an effective and relatively safe en bloc resection technique for complex colorectal lesions with the potential to avoid surgery. Further studies assessing the role of eFTR in early CRC treatment with long-term outcomes are needed.

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Referenzen

References
1 Kuellmer A, Mueller J, Caca K. et al. Endoscopic full-thickness resection for early colorectal cancer. Gastrointest Endosc 2019; 89: 1180-1189 e1181
2 Schmidt A, Bauerfeind P, Gubler C. et al. Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy 2015; 47: 719-725
3 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289
4 Andrisani G, Pizzicannella M, Martino M. et al. Endoscopic full-thickness resection of superficial colorectal neoplasms using a new over-the-scope clip system: A single-centre study. Dig Liver Dis 2017; 49: 1009-1013
5 Aepli P, Criblez D, Baumeler S. et al. Endoscopic full thickness resection (EFTR) of colorectal neoplasms with the Full Thickness Resection Device (FTRD): Clinical experience from two tertiary referral centers in Switzerland. United European Gastroenterol J 2018; 6: 463-470
6 Andrisani G, Soriani P, Manno M. et al. Colo-rectal endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD®): A multicenter Italian experience. Dig Liver Dis 2019; 51: 375-381
7 Valli PV, Mertens J, Bauerfeind P. Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD®). Surg Endosc 2018; 32: 289-299
8 von Helden A, Hildenbrand R, Sido B. et al. Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series. BMC Gastroenterol 2019; 19: 121
9 Vitali F, Naegel A, Siebler J. et al. Endoscopic full-thickness resection with an over-the-scope clip device (FTRD) in the colorectum: results from a university tertiary referral center. Endosc Int Open 2018; 6: E98-E103
10 Richter-Schrag HJ, Walker C, Thimme R. et al. Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon. Chirurg 2016; 87: 316-325
11 Velegraki MTA, Vasiliadis K, Fragaki M. et al. Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece. Ann Gastroeneterol 2019; 32: 1-7
12 Albrecht H, Raithel M, Braun A. et al. Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract. Tech Coloproctol 2019; 23: 957-963
13 Bronzwaer MES, Bastiaansen BAJ, Koens L. et al. Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a prospective observational case study. Endosc Int Open 2018; 6: E1112-E1119
14 van der Spek B, Haasnoot K, Meischl C. et al. Endoscopic full-thickness resection in the colorectum: a single-center case series evaluating indication, efficacy and safety. Endosc Int Open 2018; 6: E1227-E1234
15 Castor Electronic Data Capture. Amsterdam: 2019 Available from (Accessed: 1 May 2020): https://www.castoredc.com/
16 Schmidt A, Damm M, Caca K. Endoscopic full-thickness resection using a novel over-the-scope device. Gastroenterology 2014; 147: 740-742 e742
17 Dutch Colorectal Cancer Guideline [In Dutch]. 2014 Available from (Accessed: 7 May 2020): https://richtlijnendatabase.nl/richtlijn/colorectaal_carcinoom_crc/startpagina_-_crc.html
18 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
19 Fujiya M, Tanaka K, Dokoshi T. et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 2015; 81: 583-595
20 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
21 Kuroki Y, Hoteya S, Mitani T. et al. Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors. J Gastroenterol Hepatol 2010; 25: 1747-1753
22 Hassan C, Repici A, Sharma P. et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65: 806-820
23 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86 e17
24 Arezzo A, Passera R, Marchese N. et al. Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United European Gastroenterol J 2016; 4: 18-29
25 Buchner AM, Guarner-Argente C, Ginsberg GG. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc 2012; 76: 255-263
26 Yoshii S, Nojima M, Nosho K. et al. Factors associated with risk for colorectal cancer recurrence after endoscopic resection of T1 tumors. Clin Gastroenterol Hepatol 2014; 12: 292-302 e293
27 Yasue C, Chino A, Takamatsu M. et al. Pathological risk factors and predictive endoscopic factors for lymph node metastasis of T1 colorectal cancer: a single-center study of 846 lesions. J Gastroenterol 2019; 54: 708-717
28 Butte JM, Tang P, Gonen M. et al. Rate of residual disease after complete endoscopic resection of malignant colonic polyp. Dis Colon Rectum 2012; 55: 122-127
29 Richards CH, Ventham NT, Mansouri D. et al. An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS). Gut 2018; 67: 299-306
30 Williams JG, Pullan RD, Hill J. et al. Management of the malignant colorectal polyp: ACPGBI position statement. Colorectal Dis 2013; 15 (Suppl. 02) 1-38

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