Abstract
BackgroundEndoscopic mucosal resection (EMR) in piecemeal technique is the treatment standard for larger flat or sessile colorectal lesions. The method is burdened by a high recurrence rate mostly presenting as difficult to resect lesions. In these situations, endoscopic full thickness resection (EFTR) with an over-the-scope device offers the option of complete resection despite scar formation.MethodsWe conducted a retrospective case review of 30 consecutive EFTR interventions on small (< 20 mm), difficult to resect recurrent / residual colorectal neoplastic lesions treated by EFTR.ResultsEFTR was technically feasible in 28/30 (93,3%) of the cases with an R0 resection in 24/30 (80%) and a median procedure time (marking to full thickness resection) of 34,5 min (11–120). After the first 15 procedures, the per-protocol rate increased from 13/15 to 15/15 and the R0 resection rate increased from 9/15 (69,2%) to 15/15 (100,0%; p < 0.01). One patient suffered from a delayed perforation the day after the procedure and needed emergency surgery (3,6%). Minor bleeding occurred in 3/28 patients (10,7%) and post-interventional fever in one patient (3,6%). The 30-day mortality rate was 0%.ConclusionsEFTR with an over-the-scope device is a useful method for endoscopic resection of difficult to treat recurrent or residual colorectal neoplasia after previous endoscopic therapy. High R0 resection rates were observed after a relatively short learning curve. The complication rate in this series seems acceptable given the complexity of the resected lesions.
Highlights
Endoscopic mucosal resection (EMR) in piecemeal technique is the treatment standard for larger flat or sessile colorectal lesions
We have focused on the clinically important aspect of endoscopic treatment for difficult to resect colorectal neoplasia after previous endoscopic therapy
The study conforms to the provisions of the Declaration of Helsinki. It was approved by institutional board review of the Gemeinschaftskrankenhaus Bonn and - in accordance with federal regulations (§ 15 of the professional code / ‘Berufsordnung für die nordrheinischen Ärztinnen und Ärzte’) - specific consent to participate in this retrospective case series was waived
Summary
Endoscopic mucosal resection (EMR) in piecemeal technique is the treatment standard for larger flat or sessile colorectal lesions. The method is burdened by a high recurrence rate mostly presenting as difficult to resect lesions. In these situations, endoscopic full thickness resection (EFTR) with an over-the-scope device offers the option of complete resection despite scar formation. Polypectomy and endoscopic mucosal resection (EMR) either en bloc or in piecemeal fashion – are established treatment standards for colorectal neoplasia such as adenoma or low risk early cancer [1,2,3]. We have focused on the clinically important aspect of endoscopic treatment for difficult to resect colorectal neoplasia after previous endoscopic therapy
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