A large multicenter cohort on the use of full-thickness resection device for difficult colonic lesions.
Difficult adenomas; Endoscopic full-thickness resection; FTRD; Full-thickness resection device
BACKGROUND: Introduction of the full-thickness resection device (FTRD) has allowed endoscopic resection of difficult lesions such as those with deep wall origin/infiltration or those located in difficult anatomic locations. The aim of this study is to assess the outcomes of the FTRD among its early users in the USA.
METHODS: Patients who underwent endoscopic full-thickness resection (EFTR) for lower gastrointestinal tract lesions using the FTRD at 26 US tertiary care centers between 10/2017 and 12/2018 were included. Primary outcome was R0 resection rate. Secondary outcomes included rate of technical success (en bloc resection), achievement of histologic full-thickness resection (FTR), and adverse events (AE).
RESULTS: A total of 95 patients (mean age 65.5 ± 12.6 year, 38.9% F) were included. The most common indication, for use of FTRD, was resection of difficult adenomas (non-lifting, recurrent, residual, or involving appendiceal orifice/diverticular opening) (66.3%), followed by adenocarcinomas (22.1%), and subepithelial tumors (SET) (11.6%). Lesions were located in the proximal colon (61.1%), distal colon (18.9%), or rectum (20%). Mean lesion diameter was 15.5 ± 6.4 mm and 61.1% had a prior resection attempt. The mean total procedure time was 59.7 ± 31.8 min. R0 resection was achieved in 82.7% while technical success was achieved in 84.2%. Histologically FTR was demonstrated in 88.1% of patients. There were five clinical AE (5.3%) with 2 (2.1%) requiring surgical intervention.
CONCLUSIONS: Results from this first US multicenter study suggest that EFTR with the FTRD is a technically feasible, safe, and effective technique for resecting difficult colonic lesions.
Ichkhanian, Y; Vosoughi, K; Diehl, D L; Grimm, I S; James, T W; Templeton, A W; Hajifathalian, K; Tokar, J L; Samarasena, J B; Chehade, N El Hage; Lee, J; Chang, K; Mizrahi, M; Barawi, M; Irani, S; Friedland, S; Korc, Paul; Aadam, A A; Al-Haddad, M A; Kowalski, T E; Novikov, A; Smallfield, G; Ginsberg, G G; Oza, V M; Panuu, D; Fukami, N; Pohl, H; Lajin, Michael; Kumta, N A; Tang, S J; Naga, Y M; Amateau, S K; Brewer, G O I; Kumbhari, V; Sharaiha, R; and Khashab, Mouen A, "A large multicenter cohort on the use of full-thickness resection device for difficult colonic lesions." (2020). Articles, Abstracts, and Reports. 2951.