A large multicenter cohort on the use of full-thickness resection device for difficult colonic lesions.

Publication Title

Surgical endoscopy

Authors

Y Ichkhanian
K Vosoughi
D L Diehl
I S Grimm
T W James
A W Templeton
K Hajifathalian
J L Tokar
J B Samarasena
N El Hage Chehade
J Lee
K Chang
M Mizrahi
M Barawi
S Irani
S Friedland
Paul Korc, Department of Medicine, Division of Gastroenterology, Hoag Hospital, Newport Beach, CA.Follow
A A Aadam
M A Al-Haddad
T E Kowalski
A Novikov
G Smallfield
G G Ginsberg
V M Oza
D Panuu
N Fukami
H Pohl
Michael Lajin
N A Kumta
S J Tang
Y M Naga
S K Amateau
G O I Brewer
V Kumbhari
R Sharaiha
Mouen A Khashab

Document Type

Article

Publication Date

3-16-2020

Keywords

Difficult adenomas; Endoscopic full-thickness resection; FTRD; Full-thickness resection device

Abstract

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.

Clinical Institute

Digestive Health

Specialty/Research Institute

Gastroenterology