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Endoscopy 2024; 56(11): 831-839
DOI: 10.1055/a-2328-4753
Original article

Technical failure during colorectal endoscopic full-thickness resection: the “through thick and thin” study

Giulia Gibiino 
1   Gastroenterology and Digestive Endoscopy Units, Morgagni – Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy
,
Cecilia Binda 
1   Gastroenterology and Digestive Endoscopy Units, Morgagni – Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy
,
Luigi Giovanni Papparella 
2   Center for Endoscopic Research Therapeutics and Training (CERTT), Policlinico Agostino Gemelli University, Rome, Italy
,
Cristiano Spada
2   Center for Endoscopic Research Therapeutics and Training (CERTT), Policlinico Agostino Gemelli University, Rome, Italy
,
Gianluca Andrisani
3   Digestive Endoscopy Unit, University Campus Bio-Medico, Rome, Italy
,
Francesco Maria Di Matteo
3   Digestive Endoscopy Unit, University Campus Bio-Medico, Rome, Italy
,
Mario Gagliardi 
4   Digestive Endoscopy Unit, Ospedale Gaetano Fucito, Mercato San Severino, Italy
,
Attilio Maurano
4   Digestive Endoscopy Unit, Ospedale Gaetano Fucito, Mercato San Severino, Italy
,
Sandro Sferrazza
5   Gastroenterology and Digestive Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy
,
Francesco Azzolini
6   Gastroenterology and Gastrointestinal Endocopy, Vita-Salute San Raffaele University, Milan, Italy
,
Giuseppe Grande
7   Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero – Universitaria di Modena, Modena, Italy
,
Germana de Nucci 
 8   Gastroenterology and Endoscopy Unit, Garbagnate Milanese Hospital, Milan, Italy
,
Paola Cesaro
 9   Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
,
Giovanni Aragona
10   Gastroenterology and Hepatology Unit, Ospedale "Guglielmo da Saliceto", Piacenza, Italy
,
Vincenzo Cennamo
11   Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Bologna, Bologna, Italy
,
Pietro Fusaroli 
12   Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
,
Teresa Staiano
13   Candiolo Cancer Institute, FPO – IRCCS, Candiolo, Italy
,
Paola Soriani
14   Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, Carpi, Italy
,
Mariachiara Campanale
15   Digestive Endoscopy Unit, Galliera Hospital, Genova, Italy
,
Roberto Di Mitri
5   Gastroenterology and Digestive Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy
,
Francesco Pugliese
16   Digestive Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
,
Andrea Anderloni
17   Department of Endoscopy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
,
Alessandro Cucchetti
12   Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
,
Alessandro Repici
18   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
19   Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
,
Carlo Fabbri
1   Gastroenterology and Digestive Endoscopy Units, Morgagni – Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy
,
The “through thick and thin” study group
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT05913453 Type of study: Observational Cohort Retrospective Study
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Referred to by:

Author commentary on Giulia Gibiino et al.Endoscopy 2024; 56(11): v25-v25
DOI: 10.1055/a-2347-6380

Referred to by:

Unsuccessful colonic endoscopic full-thickness resection – failure of device or operator?Endoscopy 2024; 56(11): 840-842
DOI: 10.1055/a-2350-3023

Abstract

Background Endoscopic full-thickness resection (EFTR) is an effective and safe technique for nonlifting colorectal lesions. Technical issues or failures with the full-thickness resection device (FTRD) system are reported, but there are no detailed data. The aim of our study was to quantify and classify FTRD technical failures.

Methods We performed a retrospective study involving 17 Italian centers with experience in advanced resection techniques and the required devices. Each center shared and classified all prospectively collected consecutive failures during colorectal EFTR using the FTRD from 2018 to 2022. The primary outcome was the technical failure rate and their classification; secondary outcomes included subsequent management, clinical success, and complications.

Results Included lesions were mainly recurrent (52 %), with a mean (SD) dimension of 18.4 (7.5) mm. Among 750 EFTRs, failures occurred in 77 patients (35 women; mean [SD] age 69.4 [8.9] years). A classification was proposed: type I, snare noncutting (53 %); type II, clip misdeployment (31 %); and type III, cap misplacement (16 %). Among endoscopic treatments completed, rescue endoscopic mucosal resection was performed in 57 patients (74 %), allowing en bloc and R0 resection in 71 % and 64 %, respectively. The overall adverse event rate was 27.3 %. Pooled estimates for the rates of failure, complications, and rescue endoscopic therapy were similar for low and high volume centers (P = 0.08, P = 0.70, and P = 0.71, respectively).

Conclusions Colorectal EFTR with the FTRD is a challenging technique with a non-negligible rate of technical failure and complications. Experience in rescue resection techniques and multidisciplinary management are mandatory in this setting.

Supplementary Material



Publication History

Received: 09 November 2023

Accepted after revision: 16 May 2024

Accepted Manuscript online:
16 May 2024

Article published online:
25 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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