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

Giulia Gibiino; Cecilia Binda; Luigi Giovanni Papparella; Cristiano Spada; Gianluca Andrisani; Francesco Maria Di Matteo; Mario Gagliardi; Attilio Maurano; Sandro Sferrazza; Francesco Azzolini; Giuseppe Grande; Germana de Nucci; Paola Cesaro; Giovanni Aragona; Vincenzo Cennamo; Pietro Fusaroli; Teresa Staiano; Paola Soriani; Mariachiara Campanale; Roberto Di Mitri; Francesco Pugliese; Andrea Anderloni; Alessandro Cucchetti; Alessandro Repici; Carlo Fabbri; The “through thick and thin” study group

doi:10.1055/a-2328-4753

Endoscopy, Table of Contents

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

¹Gastroenterology and Digestive Endoscopy Units, Morgagni – Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy

,

Cecilia Binda

¹Gastroenterology and Digestive Endoscopy Units, Morgagni – Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy

,

Luigi Giovanni Papparella

²Center for Endoscopic Research Therapeutics and Training (CERTT), Policlinico Agostino Gemelli University, Rome, Italy

,

Cristiano Spada

²Center for Endoscopic Research Therapeutics and Training (CERTT), Policlinico Agostino Gemelli University, Rome, Italy

,

Gianluca Andrisani

³Digestive Endoscopy Unit, University Campus Bio-Medico, Rome, Italy

,

Francesco Maria Di Matteo

³Digestive Endoscopy Unit, University Campus Bio-Medico, Rome, Italy

,

Mario Gagliardi

⁴Digestive Endoscopy Unit, Ospedale Gaetano Fucito, Mercato San Severino, Italy

,

Attilio Maurano

⁴Digestive Endoscopy Unit, Ospedale Gaetano Fucito, Mercato San Severino, Italy

,

Sandro Sferrazza

⁵Gastroenterology and Digestive Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy

,

Francesco Azzolini

⁶Gastroenterology and Gastrointestinal Endocopy, Vita-Salute San Raffaele University, Milan, Italy

,

Giuseppe Grande

⁷Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero – Universitaria di Modena, Modena, Italy

,

Germana de Nucci

⁸Gastroenterology and Endoscopy Unit, Garbagnate Milanese Hospital, Milan, Italy

,

Paola Cesaro

⁹Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

,

Giovanni Aragona

¹⁰Gastroenterology and Hepatology Unit, Ospedale "Guglielmo da Saliceto", Piacenza, Italy

,

Vincenzo Cennamo

¹¹Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Bologna, Bologna, Italy

,

Pietro Fusaroli

¹²Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy

,

Teresa Staiano

¹³Candiolo Cancer Institute, FPO – IRCCS, Candiolo, Italy

,

Paola Soriani

¹⁴Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, Carpi, Italy

,

Mariachiara Campanale

¹⁵Digestive Endoscopy Unit, Galliera Hospital, Genova, Italy

,

Roberto Di Mitri

⁵Gastroenterology and Digestive Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy

,

Francesco Pugliese

¹⁶Digestive Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy

,

Andrea Anderloni

¹⁷Department of Endoscopy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

,

Alessandro Cucchetti

¹²Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy

,

Alessandro Repici

¹⁸Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

¹⁹Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy

,

Carlo Fabbri

¹Gastroenterology and Digestive Endoscopy Units, Morgagni – Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy

,

The “through thick and thin” study group

› Author Affiliations

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.

Full Text

References

References
1 Ichkhanian Y, Vosoughi K, Diehl DL. et al. A large multicenter cohort on the use of full‑thickness resection device for difficult colonic lesions. Surg Endosc 2021; 35: 1296-1306
2 Li P, Ma B, Gong S. et al. Efficacy and safety of endoscopic full‑thickness resection in the colon and rectum using an over‑the‑scope device: a meta‑analysis. Surg Endosc 2021; 35: 249-259
3 Aslanian HR, Sethi A. ASGE Technology Committee. et al. ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VideoGIE 2019; 4: 343-350
4 Zwager LW, Bastiaansen BAJ, van der Spek BW. et al. Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry. Endoscopy 2022; 54: 475-485
5 Kuellmer A, Mueller J, Caca K. et al. Endoscopic full-thickness resection for early colorectal cancer. Gastrointest Endosc 2019; 89: 1180-1189.e1
6 Gijsbers KM, Laclé MM, Elias SG. et al. Full-thickness scar resection after R1/Rx excised T1 colorectal cancers as an alternative to completion surgery. Am J Gastroenterol 2022; 117: 647-653
7 Fahmawi Y, Hanjar A, Ahmed Y. et al. Efficacy and safety of full-thickness resection device (FTRD) for colorectal lesions endoscopic full-thickness resection: a systematic review and meta-analysis. J Clin Gastroenterol 2021; 55: e27-e36
8 Ichkhanian Y, Barawi M, Seoud T. et al. Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience. Endoscopy 2022; 54: 16-24
9 Dolan RD, Bazarbashi AN, McCarty TR. et al. Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis. Gastrointest Endosc 2022; 95: 216-224
10 Nabi Z, Samanta J, Dhar J. et al. Device assisted endoscopic full thickness resection in colorectum: A systematic review and meta-analysis. Dig Endosc 2024; 36: 116-128
11 Krutzenbichler I, Dollhopf M, Diepolder H. et al. Technical success, resection status, and procedural complication rate of colonoscopic full-wall resection: a pooled analysis from 7 hospitals of different care levels. Surg Endosc 2021; 35: 3339-3353
12 Kumar S, Coronel MA, Romero LG. et al. Full-thickness resection: troubleshooting, tips, and tricks for success in the colorectum. VideoGIE 2022; 7: 201-204
13 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-S43
14 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085.e8
15 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
16 Meier B, Stritzke B, Kuellmer A. et al. Efficacy and safety of endoscopic full-thickness resection in the colorectum: results from the German Colonic FTRD Registry. Am J Gastroenterol 2020; 115: 1998-2006
17 Zwager LW, Bastiaansen BAJ, van der Spek BW. et al. Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry. Endoscopy 2022; 54: 475-485
18 Zwager LW, Mueller J, Stritzke B. et al. Dutch eFTR Working Group and German collaborating centers. Adverse events of endoscopic full-thickness resection: results from the German and Dutch nationwide colorectal FTRD registry. Gastrointest Endosc 2023; 97: 780-789
19 Yzet C, Le Baleur Y, Albouys J. et al. Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study. Endoscopy 2023; 55: 1002-1009
20 Andrisani G, Hassan C, Pizzicannella M. et al. Endoscopic full-thickness resection versus endoscopic submucosal dissection for challenging colorectal lesions: a randomized trial. Gastrointest Endosc 2023; 98: 987-997.e1
21 Tate DJ, Bahin FF, Desomer L. et al. Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) is an effective and safe strategy for the management of non-lifting large laterally spreading colonic lesions. Endoscopy 2018; 50: 52-62
22 Shahidi N, Vosko S, Gupta S. et al. Previously attempted large nonpedunculated colorectal polyps are effectively managed by endoscopic mucosal resection. Am J Gastroenterol 2021; 116: 958-966
23 Djinbachian R, Taghiakbari M, El Yamani MEM. et al. Cold snare and ablation technique for endoscopic mucosal resection of incompletely resected large laterally spreading tumors. Endoscopy 2023; 55: E860-E861
24 Tate DJ, Argenziano ME, Anderson J. et al. Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55: 645-679
25 Pimentel-Nunes P, Pioche M, Albéniz E. et al. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019; 51: 980-992
26 Meier B, Schmidt A, Glaser N. et al. Endoscopic full-thickness resection of gastric subepithelial tumors with the gFTRD-system: a prospective pilot study (RESET trial). Surg Endosc 2020; 34: 853-860
27 Abdallah M, Suryawanshi G, McDonald N. et al. Endoscopic full-thickness resection for upper gastrointestinal tract lesions: a systematic review and meta-analysis. Surg Endosc 2023; 37: 3293-3305
28 Zaheer N, Basha J, Inavolu P. et al. Exposed versus nonexposed endoscopic full-thickness resection for duodenal subepithelial lesions: a tertiary care center experience (with videos). iGIE 2023; 2: 154-160.e2
29 Mun EJ, Wagh MS. Recent advances and current challenges in endoscopic resection with the full-thickness resection device. World J Gastroenterol 2023; 29: 4009-4020

Supplementary Material

Supplementary material