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DOI: 10.1055/s-0039-1681573
SAFETY AND FEASIBILITY OF ENDOSCOPIC FULL-THICKNESS RESECTION IN COLORECTUM USING OVER THE SCOPE CLIP. A MULTICENTER SPANISH EXPERIENCE 2015 – 2018
Publication History
Publication Date:
18 March 2019 (online)
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.