Endoscopic full-thickness resection versus endoscopic submucosal dissection for challenging colorectal lesions: a randomized trial

Abstract

The optimal endoscopic resection method of challenging colorectal lesions, (i.e. adenomatous recurrences, laterally spreading non-granular tumors (LST-NG), lesions without lifting sign <30mm), is still under debate. Aim of our study was to directly compare Endoscopic Submucosal Dissection (ESD) and Endoscopic Full Thickness Resection (EFTR) for the resection of challenging colorectal lesions in a randomized trial. We underwent a multicenter prospective randomized study in four Italian referral centers. Consecutive patients referred for endoscopic resection of challenging lesions were randomly assigned to receive EFTR or ESD. Primary outcomes were R0 resection and en-bloc resection of lesions. We also compared technical success, procedure time, procedure speed, area of the resected specimen, complication rate and local recurrence rate at 6 months. Overall, 90 patients were included in the study, equally representing the three challenging lesion types. Age and sex were comparable in the two groups. En-bloc resection was obtained in 95.5% in EFTR group and in 93.3% in ESD group. R0 resection rate was comparable in the two groups (EFTR vs ESD: 42 [93.3%] vs 36 [80%], p=0.06. EFTR group showed a significantly shorter total procedure time (25.6 [10.6] vs 76.7 [26.4] minutes, p=<0.01) as well as overall procedure speed (16.8 [11.8] vs 11.9 [9.2] mm2/min, p=0.0.3). EFTR group showed a significantly smaller mean lesion size (21.6 mm [8.3] vs 28.7 mm [7.7], p=<0.01. Complications were reported less frequently in patients in the EFTR group (4.44 vs. 15.5 %, p=0.04). EFTR is comparable to ESD in the treatment of challenging colorectal lesions in terms of safety and efficacy. EFTR is considerably faster than ESD in the treatment of non-lifting lesions and adenoma recurrences.