Mo1630 ENDOSCOPIC FULL THICKNESS RESECTION VERSUS ENDOSCOPIC SUBMUCOSAL DISSECTION IN COLORECTAL NEOPLASIA THERAPY – BICENTRIC PROSPECTIVE RANDOMIZED STUDY

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Colorectal neoplasia can be treated by several established endoscopic methods such as endoscopic submucosal dissection (ESD). Recently new method allowing the endoscopic full thickness resection (EFTR) of the colorectal wall has been introduced. Bicentric (2 academic tertiary centers) prospective randomized study comparing two methods (newly available EFTR versus standardized ESD) in endoscopic therapy of colorectal neoplasia (size ≤ 3 cm) with high risk of incomplete removal. Primary endpoint was R0 resection. Analysis was done by Fisher exact test and Mann-Whitney test and interim data are presented. 35 patients were included (71 % men, mean age 66 years), main indication were T1 cancers (46 %), non-lifting adenomas (29 %) and local residual neoplasia (23 %). EFTR was technically successful in 90 % and ESD in 94 % (p-value 0.999). Comparing the lesions treated by EFTR (N = 19; 54 %) and ESD (N = 16; 46 %), the mean size was 18 mm and 20 mm respectively (both groups range 10 – 30 mm), the localization was dominantly in right colon (63 %) for EFTR group and rectum (62 %) for ESD group. In both groups most lesions were assessed as 0-IIa + II c (26 % and 50 % respectively) according to the Paris classification. The histopathology results for EFTR and ESD were as follows: 14 benign lesions (40 %; 64 % of them with high-grade dysplasia) and 21 (60 %) malignant lesions (7 intramucosal cancers, 12 T1 cancers and two T2 cancers). R0 resection was achieved in 17 patients (90 %) in EFTR group and 13 patients (81 %) in ESD group (p-value 0,785), curative resection of malignant lesions was performed in 46 % (5/11; EFTR) and 60% (6/10; ESD) patients (p-value 0,670). There were 4 cases of perforation (11%; all in ESD group), 2 (6 %) were treated endoscopically and in 2 cases (6 %) surgical therapy was necessary. Both EFTR and ESD are technically effective methods for therapy of colorectal neoplasia with high risk of incomplete removal. EFTR is non-significantly superior in achieving R0 resections and ESD is more effective in early cancers curative resections. EFTR seems to be more safe method comparing to ESD.