EFTR WITH OTSC IN COLORECTUM: WHAT HAPPENS WHEN THE LESION IS TRAPPED IN THE OVER-THE-SCOPE-CLIP AND IS NOT RESECTED

Aims:

Endoscopic full-thickness resection (EFTR) in the colorectum using the FTRD may be difficult sometimes due to poor traction or loosing of the resection plane, and part of the lesion or the whole of it might get trapped inside the over-the-scope clip (OTSC).

Our aim was to study the outcomes of these patients with the lesion trapped in the OTSC.

Methods:

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.

Cases of technical failure with part or the entire lesion trapped inside the OTSC were analyzed.

Results:

68 cases of EFTR were evaluated.

In 10 cases, the lesion was trapped in the OTSC and could not be resected properly.

The mean age of the patients was 71 years, being men 80%.

Indications were: non-lifting sign recurrent lesions (6 cases), non-lifting sign untreated lesions (1), incomplete resection with non-lifting sign (2), appendicular lesions (1).

Location were appendix (1 case), stump (1), right colon (1), transverse colon (2), left colon (2), sigma (2), rectosigmoid junction (1).

The mean diameter of the lesion was 19 mm.

In 8 cases there was a partial resection of the lesion (mean diameter of the lesion 18 mm), and in 2 cases only biopsies were taken.

Final histology: LGD (4 cases), HGD (2), intramucosal adenocarcinoma (1), SSP (2), advanced adenocarcinoma >sm2 (2).

In the follow-up, three lesiones underwent surgery (appendicular lesion and advanced adenocarcinoma), 3 residual lesions were treated endoscopically and in 4 cases the scar showed no residual tissue.

Conclusions:

In some cases of intended EFTR, residual tissue trapped inside the OTSC might be easily treated endoscopically and sometimes might be treated by the OTSC itself, if the residual lesion is small.