Yazan Fahmawi, MD1, Manoj Kumar, MD1, Baret Bercier, MD2, Rufaat Mando, MD3, Meir Mizrahi, MD4
1University of South Alabama, Mobile, AL; 2University of South Alabama College of Medicine, Mobile, AL; 3University of South Alabama College of Medicine, Mando, AL; 4University of South Alabama College of Medicine, Spanish Fort, AL
Introduction: While endoscopic transmural resection (EMR) and endoscopic submucosal dissection (ESD) are the conventional endoscopic resection methods for gastrointestinal (GI) lesions, endoscopic full-thickness resection (eFTR) is a promising minimally invasive modality for gastrointestinal lesions resection with good outcomes and less complications compared to EMR and ESD. Full thickness resection device (FTRD) is an over-the-scope device that has been developed for one-step eFTR. In this study, we report our experience with FTRD for GI lesions.
Methods: We retrospectively analyzed data from 17 patients who underwent eFTR with FTRD at our institution. Complete resection (R0), technical success, and clinical outcomes were studied.
Results: The indications for eFTR were recurrent/residual adenoma (12 cases), primary non-lifting adenoma (2 cases), submucosal lesions resection (2 cases), and early carcinoma (1 case). Eleven patients were males and six were females. The median age was 60 years (range 32-84). Locations of the lesions were: (3) in the cecum, (8) in the ascending colon, (2) in the transverse colon, (2) in the hepatic flexure, (1) in the rectum, and (1) in the stomach. Technical success rate was 13/17 (76%). Three of the unsuccessful attempts were due to inability to advance the endoscope to the cecum in one case and inability to pull up fibrotic lesions in the other two cases. The fourth unsuccessful case was due to device malfunction as the lesion was snared but the clip was not deployed. The mean maximum diameter of lesions after resection was 18.3 mm (range 13-22). R0 resection rate was 14/14 (100%). Microscopic full-thickness resection was achieved in 43% (6/14). The median procedure time was 67 minutes (range 31-140). The case with the device malfunction was complicated by perforation and delayed minor bleeding. The perforation was managed during the procedure with hemostatic clips. Another case had delayed minor bleeding without requiring blood transfusion. All patients were discharged on the same day except patients with complication as they required 1-2 days of inpatient observation.
Discussion: eFTR using FTRD is a safe minimally invasive procedure with good clinical outcomes. eFTR is currently indicated for treatment of non-lifting lesions, incomplete polypectomy, submucosal
Citation: Yazan Fahmawi, MD; Manoj Kumar, MD; Baret Bercier, MD; Rufaat Mando, MD; Meir Mizrahi, MD. P1010 - ENDOSCOPIC FULL-THICKNESS RESECTION OF GASTROINTESTINAL LESIONS WITH THE OVER-THE-SCOPE DEVICE: A SINGLE CENTER EXPERIENCE. Program No. P1010. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.