Outcomes in EFTR with Ftrd-System: when Patient Selection is Crucial

Aims Endoscopic full-thickness resection (EFTR) with FTRD-system is a novel treatment for gastrointestinal lesions not suitable for conventional endoscopic resection. Aim of this retrospective single centre study was to assess its efficacy and safety.

Methods Thirty-six patients (18 male, 18 female; mean age 79 years, range 51-86) were recruited to perform EFTR using FTRD-system: 21 colon, 9 rectum (13 residual/recurrent adenoma, 9 non-lifting lesions, 3 incomplete resections at histology, 4 endoscopically suspected T1 carcinoma, 1 subepithelial lesions); 5 duodenal (4 non polypoid lesions, 1 subepithelial lesion); 1 gastric for early gastric cancer. Technical success (lesion reached and resected), R0 resection (negative lateral and deep margins), EFTR rate (all layers in the specimen) and adverse events (AE) were evaluated.

Results Technical success was achieved in all of cases. EFTR rate was achieved in 93,3 % of colorectal EFTR, and in 100 % of gastro-duodenal EFTR. R0 resection rate was 93,2 % in colorectal EFTR and 100 % in gastro-duodenal EFTR. All histological assessments are presented in [table 1]. AEs occurred in 16,5 % (2 bleeding, 1 perforation, 2 post-polipectomy syndrome) of colorectal EFTR and in 20 % (1 bleeding) of gastro-duodenal cases: only one snare malfunction occurred in a colorectal case. Six month follow-up was available in 27 cases: no evidence of residual disease or stenosis were registered.

Table 1 Results

Indication, n (%)
Colo-rectal EFTR
Residual/recurrent adenoma	13 (43,3 %)
Non-lifting lesion	9 (3 %)
Suspected T1 carcinoma	4 (13,3 %)
Histological R1 resection	3 (10 %)
Submucosal lesion Duodenal EFTR Non-lifting lesion Submucosal lesion	1 (3,3 %) 4 (80 %)1 (20 %)
Gastric EFTR
Early gastric cancer	1 (100 %)
Diameter of lesion (mm), mean, (range)
Colo-rectal EFTR	17 (4-32)
Duodenal EFTR	21 (13-35)
Gastric EFTR	20
Technical success, n (%)
Colo-rectal EFTR	30 (100 %)
Duodenal EFTR	5 (100 %)
Gastric EFTR	1 (100 %)
EFTR resection, n (%)
Colo-rectal EFTR	28 (93,2 %)
Duodenal EFTR	5 (100 %)
Gastric EFTR	1 (100 %)
R0 resection, n (%)
Colo-rectal EFTR	28 (93,2 %)
Duodenal EFTR	5 (100 %)
Gastric EFTR	1 (100 %)
Histology, n (%)
Colo-rectal EFTR
High grade dysplasia adenoma	13 (43,3 %)
Low grade dysplasia adenoma	4 (13,3 %)
Low risk T1 carcinoma	3 (10 %)
High risk T1 carcinoma	5 (16,6 %)
Scar tissue	4 (13,3 %)
Neuroendocrine tumor	1 (3,3 %)
Duodenal EFTR
High-grade dysplasia adenoma	4 (80 %)
Neuroendocrine tumor	1 (20 %)
Gastric EFTR
Early gastric cancer	1 (100 %)
Adverse events, n (%)
Colo-rectal EFTR
Bleeding	2 (6,6 %)
Perforation	1 (3,3 %)
Post-polipectomy syndrome	2 (6,6 %)
Duodenal EFTR
Bleeding	1 (20 %)
Technical adverse events (colo-rectal EFTR), n (%)
Snare malfunction	1 (3,3 %)
Six-month follow-up
Residual disease/stenosis n (%)	0 (0 %)

Conclusions Our data confirm that an appropriate patient selection is crucial to improve outcomes. EFTR using FTRD-system seems to be a curative, effective and safe technique for treatment of selected lesions that would otherwise need surgery.

Citation: Soriani P, Curatolo A, Vavassori S et al. OP161 OUTCOMES IN EFTR WITH FTRD-SYSTEM: WHEN PATIENT SELECTION IS CRUCIAL. Endoscopy 2021; 53: S65.

Publication History

Article published online:
19 March 2021