Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis
Background and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and sub-epithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTR...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2020-02-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1073-7593 |
| _version_ | 1818529051358265344 |
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| author | Olaya I. Brewer Gutierrez Venkata S. Akshintala Yervant Ichkhanian Gala G. Brewer Yuri Hanada Maria P. Truskey Amol Agarwal Gulara Hajiyeva Vivek Kumbhari Anthony N. Kalloo Mouen A. Khashab Saowanee Ngamruengphong |
| author_facet | Olaya I. Brewer Gutierrez Venkata S. Akshintala Yervant Ichkhanian Gala G. Brewer Yuri Hanada Maria P. Truskey Amol Agarwal Gulara Hajiyeva Vivek Kumbhari Anthony N. Kalloo Mouen A. Khashab Saowanee Ngamruengphong |
| author_sort | Olaya I. Brewer Gutierrez |
| collection | DOAJ |
| description | Background and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and sub-epithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTRD or over-the-scope clip of gastrointestinal tumors.
Methods A comprehensive literature search was performed. The primary outcome of interest was the rate of histologic complete resection (R0). Secondary outcomes of interest were the rate of enbloc resection, FTR, adverse events, and post-EFTR surgery. Random-effects model was used to calculate pooled estimates and generate forest plots.
Results Eighteen studies with 730 patients and 733 lesions were included in the analyses. Indications for EFTR were difficult/residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice and early cancer (n = 634), colorectal SELs (n = 42), and upper gastrointestinal lesions (n = 51), other colonic lesions (n = 6). Median size of lesions was 13.5 mm. There were 22 failed EFTR attempts. Pooled overall R0 resection rate was 82 % (95 % CI: 75, 89). The pooled overall FTR rate was 83 % (95 % CI: 77, 89). The pooled overall enbloc resection rate was 95 (95 % CI: 92, 96). The pooled estimates for perforation and bleeding were < 0.1 % and 2 %, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason [pooled rate 7 % (95 % 2, 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4 %, < 0.1 % and < 0.1 %, respectively. No mortality related to EFTR was noted.
Conclusions EFTR appears to be safe and effective for gastrointestinal lesions that are not amenable to conventional endoscopic resection. This technique should be considered as an alternative to surgery in selected cases. |
| first_indexed | 2024-12-11T06:58:05Z |
| format | Article |
| id | doaj.art-6d375a38f7794d108b69850dfc34e926 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-11T06:58:05Z |
| publishDate | 2020-02-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-6d375a38f7794d108b69850dfc34e9262022-12-22T01:16:42ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362020-02-010803E313E32510.1055/a-1073-7593Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysisOlaya I. Brewer Gutierrez0Venkata S. Akshintala1Yervant Ichkhanian2Gala G. Brewer3Yuri Hanada4Maria P. Truskey5Amol Agarwal6Gulara Hajiyeva7Vivek Kumbhari8Anthony N. Kalloo9Mouen A. Khashab10Saowanee Ngamruengphong11Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United StatesDivision of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United StatesDivision of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United StatesDivision of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United StatesDepartment of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United StatesWilliam H. Welch Medical Library, Johns Hopkins Medical Institutions, Baltimore, Maryland, United StatesDepartment of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United StatesDepartment of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United StatesDivision of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United StatesDivision of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United StatesDivision of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United StatesDivision of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United StatesBackground and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and sub-epithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTRD or over-the-scope clip of gastrointestinal tumors. Methods A comprehensive literature search was performed. The primary outcome of interest was the rate of histologic complete resection (R0). Secondary outcomes of interest were the rate of enbloc resection, FTR, adverse events, and post-EFTR surgery. Random-effects model was used to calculate pooled estimates and generate forest plots. Results Eighteen studies with 730 patients and 733 lesions were included in the analyses. Indications for EFTR were difficult/residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice and early cancer (n = 634), colorectal SELs (n = 42), and upper gastrointestinal lesions (n = 51), other colonic lesions (n = 6). Median size of lesions was 13.5 mm. There were 22 failed EFTR attempts. Pooled overall R0 resection rate was 82 % (95 % CI: 75, 89). The pooled overall FTR rate was 83 % (95 % CI: 77, 89). The pooled overall enbloc resection rate was 95 (95 % CI: 92, 96). The pooled estimates for perforation and bleeding were < 0.1 % and 2 %, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason [pooled rate 7 % (95 % 2, 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4 %, < 0.1 % and < 0.1 %, respectively. No mortality related to EFTR was noted. Conclusions EFTR appears to be safe and effective for gastrointestinal lesions that are not amenable to conventional endoscopic resection. This technique should be considered as an alternative to surgery in selected cases.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1073-7593 |
| spellingShingle | Olaya I. Brewer Gutierrez Venkata S. Akshintala Yervant Ichkhanian Gala G. Brewer Yuri Hanada Maria P. Truskey Amol Agarwal Gulara Hajiyeva Vivek Kumbhari Anthony N. Kalloo Mouen A. Khashab Saowanee Ngamruengphong Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis Endoscopy International Open |
| title | Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis |
| title_full | Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis |
| title_fullStr | Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis |
| title_full_unstemmed | Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis |
| title_short | Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis |
| title_sort | endoscopic full thickness resection using a clip non exposed method for gastrointestinal tract lesions a meta analysis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1073-7593 |
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