Chandra S. Dasari, MD1, Venkat Nutalapati, MD2, Abhiram Duvvuri, MD3, Viveksandeep Thoguluva Chandrasekar, MD3, Afeerah Malik3, Divyanshoo Kohli, MD3, Prateek Sharma, MD, FACG4
1Kansas City VA Medical Center, Kansas City, KS; 2University of Kansas Medical Center, Kansas City, KS; 3Kansas City VA Medical Center, Overland Park, KS; 4Kansas City VA Medical Center, Kansas City, MO
Introduction: Endoscopic full thickness resection (EFTR) using the Full Thickness Resection Device (FTRD) is being increasingly used for the resection of colorectal lesions not amenable to conventional endoscopic resection. We conducted a systematic review and pooled analysis to assess the efficacy and safety of this device for resection of colorectal lesions.
Methods: An electronic database search was conducted in PubMed/MEDLINE, Embase, Google Scholar and Cochrane databases to identify studies that used EFTR for colorectal lesions using the over the scope FTRD. The primary outcome was the rate of technical success and R0 resection. Secondary outcomes included complications (bleeding, perforation and post polypectomy syndrome) and the total procedure time. Pooled rates were reported with 95% Confidence Interval (CI) with heterogeneity (I2). We used a random effects model to calculate pooled rates and used the I-square statistic to quantify heterogeneity.
Results: A total of 7 studies were included in the final analysis - 559 patients with 563 lesions removed using FTRD; mean age 67 years, males 59.3% and mean lesion size of 15.7 mm. Mean follow up of the studies was 4.0 months. The colorectal lesions resected by EFTR included: 32% cancers, .01% neuroendocrine tumors and 67% adenomas. The pooled overall technical success was 91% (95% CI 88% - 93%, I2 =0%) (Figure 1) with a R0 resection rate of 81% (95% CI 74% -86%, I2 = 62%) (Figure 2). The pooled rates of immediate bleeding, perforation, and post polypectomy syndrome were 5% 3% and 2% respectively. The overall combined rate of any complication (bleeding, perforation and post polypectomy syndrome) was 9.2% (6.1%-13.5%). The mean total procedure time was 47.76 min (95%CI 40-55, I2 = 84%). (Figure 3)
Discussion: Endoscopic full thickness resection (EFTR) using over the scope Full Thickness Resection Device (FTRD) appears to be a effective and safe technique for the resection of non-lifting colorectal lesions, with a >90% technical success rate, R0 resection rate of >80% and an overall complication rate of < 10%.
Citation: Chandra S. Dasari, MD; Venkat Nutalapati, MD; Abhiram Duvvuri, MD; Viveksandeep Thoguluva Chandrasekar, MD; Afeerah Malik; Divyanshoo Kohli, MD; Prateek Sharma, MD, FACG. P2388 - EFFICACY AND SAFETY OF ENDOSCOPIC FULL THICKNESS RESECTION (EFTR) OF COLORECTAL NEOPLASMS USING THE FULL THICKNESS RESECTION DEVICE (FTRD): A SYSTEMATIC REVIEW AND POOLED ANALYSIS. Program No. P2388. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.