Colon to Rectum
Gastrointest Endosc. 2023;98(3):405–11
Efficacy and safety of combined EMR and endoscopic full-thickness resection (hybrid EFTR) for large non-lifting colorectal adenomas
Background and aims: Endoscopic full-thickness resection (EFTR) with a full-thickness resection device (FTRD) has become the standard technique for selected non-lifting colorectal adenomas, but tumor size is the major limitation. However, large lesions might be approached in combination with endoscopic mucosal resection (EMR). Herein, the authors report the largest single-center experience to date of combined EMR and EFTR (hybrid EFTR) in patients with large (≥ 25 mm) non-lifting colorectal adenomas not amenable to EMR or EFTR alone.
Methods: This is a single-center retrospective analysis of consecutive patients who underwent hybrid EFTR of large (≥ 25 mm) non-lifting colorectal adenomas. Outcomes of technical success (successful advancement of the FTRD with consecutive successful clip deployment and snare resection), macroscopic complete resection, adverse events, and endoscopic follow-up were evaluated.
Results: 75 patients with non-lifting colorectal adenomas were included. Mean lesion size was 36.5 mm (range, 25–60 mm), and 66.6% were located in the right side of the colon. Technical success was 100% with macroscopic complete resection in 97.3%. Mean procedure time was 83.6 minutes. Adverse events occurred in 6.7%, leading to surgical therapy in 1.3%. Histology revealed T1 carcinoma in 16%. Endoscopic follow-up was available in 93.3% (mean follow-up time, 8.1 months; range, 3–36 months) and showed no signs of residual or recurrent adenoma in 88.6%. Recurrence (11.4%) was treated endoscopically.
Conclusions: Hybrid endoscopic full-thickness resection (EFTR) is safe and effective for advanced colorectal adenomas that cannot be approached by endoscopic mucosal resection or EFTR alone. Hybrid EFTR expands the indication of EFTR substantially in selected patients.