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Endoscopy
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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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

 

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Kuellmer A, Mueller J, Caca K. et al. Endoscopic full-thickness resection for early colorectal cancer. Gastrointest Endosc 2019; 89: 1180-1189.e1
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar