Real-world topographical efficacy, procedural outcome and safety of endoscopic full thickness resection in colon segments.

BACKGROUND

Despite growing evidence on endoscopic full thickness resection (EFTR), data on segment-specific outcomes in real-world patients remain limited.

AIM: To investigate segment-specific outcomes of EFTR using a full-thickness resection device (FTRD) for neoplastic colorectal lesions.

METHODS

In this multicenter, retrospective study, EFTR was conducted in unselected real-world patients referred to participating German centers after colonoscopy confirmed EFTR eligibility. The primary outcome was histologically complete resection (R0) of the lesion, including segment-specific outcomes and adverse events (AE). Additional efficacy and safety parameters were investigated by colonic topography for up to 30 days.

RESULTS

The analysis included 102 patients (64 males, 38 females) with a median age of 70 years. EFTR via FTRD was technically successful in all patients. The R0 rate was 81.4%, segment-specifically ranging from 85.0% (rectum), 84.6% (descending colon), 84.0% (ascending colon), 83.3% (cecum), and 76.5% (sigmoid colon) to 73.3% (transverse colon). Examination time was longer in proximal parts compared to the rectosigmoid (non-significant). Overall, 33 patients (32.4%) experienced AE, including only one major complication (0.98%; perforation of sigmoid colon). Abdominal postsurgical pain (18.6%), hematochezia (9.8%), and hemoglobin decline (7.8%) were the most frequent minor complications. Transverse colon lesions had the numerically highest rate of AE, with 8 of 15 patients (53.3%) affected.

CONCLUSION

EFTR is efficacious for neoplastic colorectal lesions, though R0 rates vary by location. This may impact patient education, selection of the operator, and consideration of laparoscopy surgery.