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Endoscopic full-thickness resection with the FTRD safe, effective

Tristan Manalac
13 Mar 2019

Endoscopic full-thickness resection (EFTR) using the Full Thickness Resection Device (FTRD) is a safe and effective approach to treating colorectal lesions, according to a recent Italy study.

“The EFTR compared to common endoscopic resection techniques has the considerable advantage of guaranteeing a better histological evaluation of a particular setting of lesions at high risk of fragmentary or incomplete resection,” said researchers, however noting that the procedure may prove difficult and may require the expertise of a skilled endoscopist.

The retrospective multicentre study included 110 patients (mean age 68±11 years; 61 males) with colorectal lesions who underwent EFTR using FTRD. Residual/recurrent adenoma was detected in 39 participants and was the most frequent indication, while the rectum was the most common site of resection. Mean target lesion size was 17.83 mm. [Dig Liver Dis 2019;51:375-381]

Technical success, defined as the lesion being reached and resected, was achieved in 94.34 percent (n=103) of the participants. In comparison, a full-thickness resection was successful in 91 percent (n=100), with 90 percent and 92 percent meeting lateral and deep R0 resections, respectively, upon histological examination.

Subgroup analysis showed no significant difference in the EFTR rate according to the site of the lesion (rectum vs other segments: 91 percent vs 90 percent). The mean size of the resected specimens was 20 mm.

In the subgroup of patients who underwent EFTR for residual/recurrent adenoma, the median lesion size was 16.6 mm. Histologically confirmed full-thickness resection was achieved in 88.9 percent, while complete resection was reported in 94.4 percent. The median resected specimen size was 19 mm.

R1 resection was performed in 26 participants, in whom the most common site of lesion was the rectum. An R0 resection was achieved in 86.36 percent, and EFTR was confirmed in an equal proportion of patients, yielding a median specimen size of 25.5 mm.

In terms of safety, reports of adverse clinical events were rare. Only 12 patients (11 percent) had such experiences, with only two requiring further surgical attention. Four patients reported traumatic wall lesions due to the progression of the FTRD endoscope, though none required additional treatment. One participant developed postpolypectomy syndrome.

There were also 12 instances (11 percent) of malfunction of the resection snare. The device was removed after clip deployment, and subsequent resection using a conventional snare was successful in all cases.

“To date, the only endoscopic device that allows achievement of an EFTR using a clip-and-cut technique is FTRD. The innovation of FTRD is to perform EFTR after the release of a modified [over-the-scope clips] in order to avoid free perforation of the colon,” said researchers.

The promising results of the present study suggest that EFTR with FTRD is a feasible and effective treatment approach for residual/recurrent adenoma, they continued.

However, the technique comes with its technical difficulties. “[T]he size of the cap and the presence of the cover can make achievement of lesions not localized in the rectum difficult, so this procedure must be carried out by a highly skilled endoscopist,” researchers said, noting that the lesion cutoff size is an additional barrier to the clinical application of FTRD.

“Randomized comparative and cost-analysis studies with current endoscopic and surgical resection techniques are needed to better define indications and outcomes,” they added.

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