Clinical Outcomes of Colorectal Endoscopic Full-Thickness Resection Using the Full-Thickness Resection Device: A Multicenter Study.
Colorectal EFTR using FTRD shows a technical success rate of 89% but is associated with adverse events in 16.9% of cases, highlighting the need for careful patient selection.
Where it sits
this study against the rest of the palopegteriparatide corpusSummary and findings
This study evaluated the outcomes of colorectal endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD) across 170 procedures. The mean patient age was 67 years, with a technical success rate of 89% and an R0 resection rate of 79%. Adverse events occurred in 16.9% of cases, with a median follow-up of 5 months.
Abstract
<h4>Background</h4>Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD) is an emerging technique for the management of complex colorectal lesions and early colorectal cancers. Although EFTR offers a minimally invasive alternative to surgery, data on efficacy, safety, and predictors of adverse events (AEs) remain limited. This study evaluated outcomes of colorectal EFTR using FTRD and identified patient- and lesion-related factors associated with AEs.<h4>Methods</h4>This multicenter retrospective study included patients who underwent colorectal EFTR with FTRD across 13 centers in Australia and New Zealand. Patient demographics, lesion characteristics, procedural outcomes, R0 resection rates, and AEs were analyzed.<h4>Results</h4>A total of 170 EFTR procedures were performed. The mean patient age was 67 years (standard deviation [SD] 13.7), and 57% were male. Mean procedure time was 51 min (SD 28.5). The most common indication was non-lifting lesions (36%). Technical success was achieved in 89% of cases. Adenocarcinoma was confirmed on histopathology in 23% of lesions, with an R0 resection rate of 79%. Recurrence occurred in 7.4% of cases during a median follow-up of 5 months (interquartile range [IQR] 8.5). Early and delayed AEs occurred in 4.1% and 12.9%, respectively, including post-procedural bleeding (<i>n </i>= 11), perforation (<i>n </i>= 5), and post-polypectomy syndrome (<i>n</i> = 2). Among 41 procedures involving appendiceal orifice lesions, appendicitis developed in 17% (<i>n</i> = 7). AEs were significantly associated with female sex (64% vs. 40%, <i>p</i> = 0.03) and appendiceal orifice lesions (46% vs. 21%, <i>p </i>= 0.02).<h4>Conclusion</h4>Colorectal EFTR using FTRD is effective for the resection of complex colorectal lesions. Careful patient selection and risk stratification are essential to optimize outcomes.
Background
This paper addresses the clinical question of the efficacy and safety of endoscopic full-thickness resection (EFTR) for complex colorectal lesions. Prior studies have suggested that EFTR may offer a minimally invasive alternative to traditional surgical approaches, but data on its outcomes and potential adverse events remain limited. Understanding the factors that influence outcomes in EFTR is crucial for optimizing patient selection and procedural success.
Methods
This multicenter retrospective study included 170 patients who underwent colorectal EFTR with FTRD across 13 centers in Australia and New Zealand. The study analyzed patient demographics, lesion characteristics, procedural outcomes, R0 resection rates, and adverse events. The mean procedure time was 51 minutes, and the most common indication for EFTR was non-lifting lesions.
Results
The primary endpoint showed a technical success rate of 89% for the EFTR procedures. Adenocarcinoma was confirmed in 23% of lesions, with an R0 resection rate of 79%. Recurrence was observed in 7.4% of cases during a median follow-up of 5 months. Adverse events occurred in 16.9% of cases, with early AEs at 4.1% and delayed AEs at 12.9%.
Interpretation
The findings indicate that EFTR using FTRD is effective for resecting complex colorectal lesions, with a notable technical success rate. However, while the statistical significance of the association between adverse events and factors such as female sex and appendiceal lesions is reported, the clinical significance of these findings may require further investigation. The retrospective nature of the study and the relatively short follow-up period limit the ability to draw definitive conclusions about long-term outcomes.
Key findings
- Technical success achieved in 89% of cases.
- R0 resection rate of 79%.
- Recurrence occurred in 7.4% of cases during a median follow-up of 5 months.
- Early AEs occurred in 4.1% and delayed AEs in 12.9%.
- Appendicitis developed in 17% of procedures involving appendiceal orifice lesions.
- AEs significantly associated with female sex (64% vs. 40%, p=0.03) and appendiceal orifice lesions (46% vs. 21%, p=0.02).
Limitations
- Retrospective study design.
- Short median follow-up of 5 months.
- Potential selection bias.
- Single-site data from 13 centers may limit generalizability.
- No long-term outcome data reported.