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Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video)

Abstract

Background

Clip-assisted endoscopic full-thickness resection (EFTR) with an over-the-scope device has been recently described to be feasible and effective for the resection of non-lifting adenomas in the lower gastrointestinal tract. However, tumor size is the major limitation of that technique. We describe a hybrid technique using endoscopic mucosal resection (EMR) in ten patients with large non-lifting colorectal adenomas to reduce tumor size and facilitate clip-assisted EFTR.

Methods

Data of ten consecutive patients (median age 72.5 years, SD 8.86) who underwent combined EMR and EFTR in the colon were analyzed retrospectively. The main outcome measures were technical success, histological confirmation of full-thickness resection, and adverse events.

Results

All lesions (median size 35.5 mm, SD 5.99) could be resected successfully. No immediate or delayed adverse events were observed. Histology confirmed full-thickness resection in all cases. Three-month follow-up showed no residual or recurrent adenomas.

Conclusions

Hybrid EMR–EFTR in the colon seems to be an effective approach for large non-lifting lesions with positive lateral lifting signs. Prospective studies are needed to further evaluate efficacy, safety, rate of recurrence, and long-term outcome of this technique.

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Fig. 1

(Reprinted with permission from Ovesco Endoscopy, Tübingen, Germany)

Fig. 2

(Reprinted with permission from Ovesco Endoscopy, Tübingen, Germany)

Fig. 3

Abbreviations

CE:

Conformité Européenne

d:

Days

EFTR:

Endoscopic full-thickness resection

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

F:

Female

FTRD:

Full-thickness resection device

GI:

Gastrointestinal

LST-G:

Lateral spreading type-granular

M:

Male

min:

Minutes

mm:

Millimeters

NBI:

Narrow band imaging

NICE:

NBI (narrow band imaging) international colorectal endoscopic

OTSC:

Over-the-scope clip

R0:

Complete resection

y:

Years

References

  1. 1.

    Schurr MO, Baur FE, Krautwald M et al (2015) Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study. Surg Endosc 29(8):2434–2441

  2. 2.

    Schmidt A, Damm M, Caca K (2014) Endoscopic full-thickness resection using a novel over-the-scope device. Gastroenterology 147(4):740–742

  3. 3.

    Richter-Schrag HJ, Walker C, Thimme R, Fischer A (2016) [Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon]. Chirurg 87(4):316–325

  4. 4.

    Schmidt A, Bauerfeind P, Gubler C, Damm M, Bauder M, Caca K (2015) Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy 47(8):719–725

  5. 5.

    Schmidt A, Riecken B, Damm M, Cahyadi O, Bauder M, Caca K (2014) Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 46(9):762–766

  6. 6.

    Schostek S, Ho CN, Melbert M et al (2015) DC current pulses for OTSC clip fragmentation: technology and experimental study. Surg Endosc 29(8):2418–2422

  7. 7.

    Kuroki Y, Hoteya S, Mitani T et al (2010) Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors. J Gastroenterol Hepatol 25(11):1747–1753

  8. 8.

    Maguire LH, Shellito PC (2014) Endoscopic piecemeal resection of large colorectal polyps with long-term followup. Surg Endosc 28(9):2641–2648

  9. 9.

    Moss A, Williams SJ, Hourigan LF et al (2015) Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 64(1):57–65

  10. 10.

    Rahmi G, Tanaka S, Ohara Y et al (2015) Efficacy of endoscopic submucosal dissection for residual or recurrent superficial colorectal tumors after endoscopic mucosal resection. J Dig Dis 16(1):14–21

  11. 11.

    Sakamoto T, Saito Y, Matsuda T, Fukunaga S, Nakajima T, Fujii T (2011) Treatment strategy for recurrent or residual colorectal tumors after endoscopic resection. Surg Endosc 25(1):255–260

  12. 12.

    Fujiya M, Tanaka K, Dokoshi T et al (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81(3):583–595

  13. 13.

    Schmidt A, Meier B, Caca K (2015) Endoscopic full-thickness resection: Current status. World J Gastroenterol 21(31):9273–9285

  14. 14.

    Kopelman Y, Siersema PD, Nir Y et al (2009) Endoluminal compression clip: full-thickness resection of the mesenteric bowel wall in a porcine model. Gastrointest Endosc 70(6):1146–1157

  15. 15.

    Zhou PH, Yao LQ, Qin XY et al (2011) Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 25(9):2926–2931

  16. 16.

    Sarker S, Gutierrez JP, Council L, Brazelton JD, Baig KRKK, Monkemuller K (2014) Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract. Endoscopy 46(9):758–761

  17. 17.

    Walz B, von RD, Schmidt A, Caca K (2011) Endoscopic full-thickness resection of subepithelial tumors with the use of resorbable sutures (with video). Gastrointest Endosc 73(6):1288–1291

  18. 18.

    Fischer A, Knoop RF, Walker C, Thimme R, Richter-Schrag HJ (2015) Resection of a large rectal polyp with the simultaneous combination of snare polypectomy and full-thickness resection device resection. Endoscopy 47(Suppl 1):E607–E608

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Acknowledgements

We thank Ovesco Endoscopy for the technical support. We also thank Professor Dr. Hermann and Dr. Mühleisen from the Department of Pathology at our institution for providing the histologic images.

Author information

Correspondence to Benjamin Meier.

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Disclosures

Prof. Caca and Dr. Schmidt have received lecture fees for FTRD training courses from Ovesco Endoscopy. Dr. Meier has no conflicts of interest or financial ties to disclose.

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Supplementary material 1 (MOV 85064 KB)

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Meier, B., Caca, K. & Schmidt, A. Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video). Surg Endosc 31, 4268–4274 (2017). https://doi.org/10.1007/s00464-017-5461-9

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Keywords

  • Full-thickness resection
  • FTRD
  • Large non-lifting adenomas