Clinical Outcomes of Colorectal Endoscopic Full-Thickness Resection Using the Full-Thickness Resection Device: A Multicenter Study.

BACKGROUND

Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD) is an emerging technique for the management of complex colorectal lesions and early colorectal cancers. Although EFTR offers a minimally invasive alternative to surgery, data on efficacy, safety, and predictors of adverse events (AEs) remain limited. This study evaluated outcomes of colorectal EFTR using FTRD and identified patient- and lesion-related factors associated with AEs.

METHODS

This multicenter retrospective study included patients who underwent colorectal EFTR with FTRD across 13 centers in Australia and New Zealand. Patient demographics, lesion characteristics, procedural outcomes, R0 resection rates, and AEs were analyzed.

RESULTS

A total of 170 EFTR procedures were performed. The mean patient age was 67 years (standard deviation [SD] 13.7), and 57% were male. Mean procedure time was 51 min (SD 28.5). The most common indication was non-lifting lesions (36%). Technical success was achieved in 89% of cases. Adenocarcinoma was confirmed on histopathology in 23% of lesions, with an R0 resection rate of 79%. Recurrence occurred in 7.4% of cases during a median follow-up of 5 months (interquartile range [IQR] 8.5). Early and delayed AEs occurred in 4.1% and 12.9%, respectively, including post-procedural bleeding (n = 11), perforation (n = 5), and post-polypectomy syndrome (n = 2). Among 41 procedures involving appendiceal orifice lesions, appendicitis developed in 17% (n = 7). AEs were significantly associated with female sex (64% vs. 40%, p = 0.03) and appendiceal orifice lesions (46% vs. 21%, p = 0.02).

CONCLUSION

Colorectal EFTR using FTRD is effective for the resection of complex colorectal lesions. Careful patient selection and risk stratification are essential to optimize outcomes.