Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series
Abstract Background Endoscopic mucosal resection (EMR) in piecemeal technique is the treatment standard for larger flat or sessile colorectal lesions. The method is burdened by a high recurrence rate mostly presenting as difficult to resect lesions. In these situations, endoscopic full thickness res...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Gastroenterology |
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| Online Access: | http://link.springer.com/article/10.1186/s12876-019-1043-8 |
| _version_ | 1819194883292790784 |
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| author | Annabell von Helden Ralf Hildenbrand Bernd Sido Franz Ludwig Dumoulin |
| author_facet | Annabell von Helden Ralf Hildenbrand Bernd Sido Franz Ludwig Dumoulin |
| author_sort | Annabell von Helden |
| collection | DOAJ |
| description | Abstract Background Endoscopic mucosal resection (EMR) in piecemeal technique is the treatment standard for larger flat or sessile colorectal lesions. The method is burdened by a high recurrence rate mostly presenting as difficult to resect lesions. In these situations, endoscopic full thickness resection (EFTR) with an over-the-scope device offers the option of complete resection despite scar formation. Methods We conducted a retrospective case review of 30 consecutive EFTR interventions on small (< 20 mm), difficult to resect recurrent / residual colorectal neoplastic lesions treated by EFTR. Results EFTR was technically feasible in 28/30 (93,3%) of the cases with an R0 resection in 24/30 (80%) and a median procedure time (marking to full thickness resection) of 34,5 min (11–120). After the first 15 procedures, the per-protocol rate increased from 13/15 to 15/15 and the R0 resection rate increased from 9/15 (69,2%) to 15/15 (100,0%; p < 0.01). One patient suffered from a delayed perforation the day after the procedure and needed emergency surgery (3,6%). Minor bleeding occurred in 3/28 patients (10,7%) and post-interventional fever in one patient (3,6%). The 30-day mortality rate was 0%. Conclusions EFTR with an over-the-scope device is a useful method for endoscopic resection of difficult to treat recurrent or residual colorectal neoplasia after previous endoscopic therapy. High R0 resection rates were observed after a relatively short learning curve. The complication rate in this series seems acceptable given the complexity of the resected lesions. |
| first_indexed | 2024-12-23T02:03:56Z |
| format | Article |
| id | doaj.art-e3ea9b093ad341e1b6888ecaa4d41143 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-23T02:03:56Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-e3ea9b093ad341e1b6888ecaa4d411432022-12-21T18:03:56ZengBMCBMC Gastroenterology1471-230X2019-07-011911610.1186/s12876-019-1043-8Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case seriesAnnabell von Helden0Ralf Hildenbrand1Bernd Sido2Franz Ludwig Dumoulin3Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Academic Teaching Hospital, University of BonnInstitute for Pathology Bonn-DuisdorfDepartment of General and Abdominal Surgery, Gemeinschaftskrankenhaus Bonn, Academic Teaching Hospital, University of BonnDepartment of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Academic Teaching Hospital, University of BonnAbstract Background Endoscopic mucosal resection (EMR) in piecemeal technique is the treatment standard for larger flat or sessile colorectal lesions. The method is burdened by a high recurrence rate mostly presenting as difficult to resect lesions. In these situations, endoscopic full thickness resection (EFTR) with an over-the-scope device offers the option of complete resection despite scar formation. Methods We conducted a retrospective case review of 30 consecutive EFTR interventions on small (< 20 mm), difficult to resect recurrent / residual colorectal neoplastic lesions treated by EFTR. Results EFTR was technically feasible in 28/30 (93,3%) of the cases with an R0 resection in 24/30 (80%) and a median procedure time (marking to full thickness resection) of 34,5 min (11–120). After the first 15 procedures, the per-protocol rate increased from 13/15 to 15/15 and the R0 resection rate increased from 9/15 (69,2%) to 15/15 (100,0%; p < 0.01). One patient suffered from a delayed perforation the day after the procedure and needed emergency surgery (3,6%). Minor bleeding occurred in 3/28 patients (10,7%) and post-interventional fever in one patient (3,6%). The 30-day mortality rate was 0%. Conclusions EFTR with an over-the-scope device is a useful method for endoscopic resection of difficult to treat recurrent or residual colorectal neoplasia after previous endoscopic therapy. High R0 resection rates were observed after a relatively short learning curve. The complication rate in this series seems acceptable given the complexity of the resected lesions.http://link.springer.com/article/10.1186/s12876-019-1043-8Colorectal neoplasiaEndoscopic full thickness resectionAdenoma recurrenceFibrosisPerforationBleeding |
| spellingShingle | Annabell von Helden Ralf Hildenbrand Bernd Sido Franz Ludwig Dumoulin Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series BMC Gastroenterology Colorectal neoplasia Endoscopic full thickness resection Adenoma recurrence Fibrosis Perforation Bleeding |
| title | Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series |
| title_full | Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series |
| title_fullStr | Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series |
| title_full_unstemmed | Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series |
| title_short | Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent / residual colorectal neoplasia: a single-center case series |
| title_sort | endoscopic full thickness resection using an over the scope device for treatment of recurrent residual colorectal neoplasia a single center case series |
| topic | Colorectal neoplasia Endoscopic full thickness resection Adenoma recurrence Fibrosis Perforation Bleeding |
| url | http://link.springer.com/article/10.1186/s12876-019-1043-8 |
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