900 Efficacy and Safety of Endoscopic Full-Thickness Resection Device (FTRD) for Gastrointestinal Lesions Full-Thickness Resection: A Meta-Analysis Study

Abstract

INTRODUCTION: Endoscopic full-thickness resection (EFTR) is an emerging minimally invasive resection procedure for GI lesions not amenable to conventional resection methods. Endoscopic full-thickness resection device (FTRD) is an over-the-scope single-step device that has been developed recently for EFTR. In this meta-analysis, we aim to assess efficacy and safety of FTRD for EFTR of GI lesions. METHODS: Methods: A comprehensive literature review was performed. Studies with < 5 cases were excluded. Rates of histologic complete resection (R0), technical success, and complications were extracted. Pooled estimates and the 95% CI were calculated depending on heterogenicity. Heterogenicity was assessed using I2 statistics. RESULTS: Nine studies (5 retrospective and 4 prospective) including 480 patients with 489 lesions were included. Indications were difficult adenomas (355), early carcinoma (82), and subepithelial lesions (SEL) (47). Locations of the lesions: stomach (5), duodenum (20), proximal colon (220), distal colon (98), and rectum (141). 57% of patients were male with median of age 66.5 years (range 20-92). Mean size of the lesions was 15.36 mm (range 1-40). Median procedure time was 46.56 minutes (range 3-190). Mean hospital stay was 3.23 days (range 0-11). Pooled overall R0 resection rate and technical success rate were 81.12% (95% CI: 77.63-84.6; I2 56.7%) and 90.39% (95% CI: 87.76-93.00; I2 10.2%), respectively. The pooled R0 resection rate was 81.59% (95% CI: 76.96-85.63) for difficult adenomas, 83.47% (95% CI: 73.19-91.00) for early carcinomas, and 81.59% (95% CI:68.25-91.05) for SELs. For locations; R0 resection rate were 78.42% (95% CI: 72.17-85.50), 76.97% (95% CI: 62.56-87.88), and 80.59% (95% CI: 67.56-90.09) for proximal, distal colon, and rectum, respectively. The complications were as follows: minor bleeding 2.89 (95% CI: 1.60-4.76), major bleeding 0.88 (95% CI: 0.26-2.15), perforation 2.23% (95% CI: 1.12-3.95), postpolypectomy syndrome 1.26% (95% CI: 0.48-2.68), local trauma 0.9% (95% CI: 0.27-2.19), and other complications 1.91% (95% CI: 0.90-3.54). Of 50 patients with peri-appendicular lesion, the rate of appendicitis was 14.29% (95% CI: 6.38-26.23). The rate of complications that required surgery was 1.55 (95% CI: 0.66-3.06). No procedural death related was found. There was no correlation between mean lesion’s size and complications rates CONCLUSION/DISCUSSION: FTRD is a safe and effective procedure for lesions not suitable for conventional resection.