Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications
| Autor: | Robert Thimme, Martin Goetz, Martin Faehndrich, David Albers, Thomas Frieling, Helmut Messmann, Michael Birk, Alexander Meining, HJ Richter-Schrag, Brigitte Schumacher, Andreas Probst, Torsten Beyna, Karel Caca, Horst Neuhaus, B. Riecken, Arthur Schmidt |
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| Rok vydání: | 2017 |
| Předmět: |
Adenoma
Adult Male medicine.medical_specialty 03 medical and health sciences Postoperative Complications 0302 clinical medicine Emergency surgery Clinical endpoint Humans Medicine Endoscopic resection Prospective Studies Full thickness resection Adverse effect Trial registration Aged Aged 80 and over business.industry Patient Selection Carcinoma Gastroenterology Cancer Colonoscopy Middle Aged medicine.disease Surgery Treatment Outcome 030220 oncology & carcinogenesis Colonic Neoplasms Female 030211 gastroenterology & hepatology Radiology business Complication Follow-Up Studies |
| Zdroj: | Gut. 67:1280-1289 |
| ISSN: | 1468-3288 0017-5749 |
| Popis: | ObjectiveEndoscopic full-thickness resection (EFTR) is a novel treatment of colorectal lesions not amenable to conventional endoscopic resection. The aim of this prospective multicentre study was to assess the efficacy and safety of the full-thickness resection device.Design181 patients were recruited in 9 centres with the indication of difficult adenomas (non-lifting and/or at difficult locations), early cancers and subepithelial tumours (SET). Primary endpoint was complete en bloc and R0 resection.ResultsEFTR was technically successful in 89.5%, R0 resection rate was 76.9%. In 127 patients with difficult adenomas and benign histology, R0 resection rate was 77.7%. In 14 cases, lesions harboured unsuspected cancer, another 15 lesions were primarily known as cancers. Of these 29 cases, R0 resection was achieved in 72.4%; 8 further cases had deep submucosal infiltration >1000 µm. Therefore, curative resection could only be achieved in 13/29 (44.8%). In the subgroup with SET (n=23), R0 resection rate was 87.0%. In general, R0 resection rate was higher with lesions ≤2 cm vs >2 cm (81.2% vs 58.1%, p=0.0038). Adverse event rate was 9.9% with a 2.2% rate of emergency surgery. Three-month follow-up was available from 154 cases and recurrent/residual tumour was evident in 15.3%.ConclusionEFTR has a reasonable technical efficacy especially in lesions ≤2 cm with acceptable complication rates. Curative resection rate for early cancers was too low to recommend its primary use in this indication. Further comparative studies have to show the clinical value and long-term outcome of EFTR in benign colorectal lesions.Trial registration numberNCT02362126; Results. |
| Databáze: | OpenAIRE |
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