A large multicenter cohort on the use of full-thickness resection device for difficult colonic lesions,Surgical Endoscopy

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A large multicenter cohort on the use of full-thickness resection device for difficult colonic lesions
Surgical Endoscopy ( IF 3.1 ) Pub Date : 2020-03-16 , DOI: 10.1007/s00464-020-07504-9
Y Ichkhanian ₁ , K Vosoughi ₁ , D L Diehl ₂ , I S Grimm ₃ , T W James ₃ , A W Templeton ₄ , K Hajifathalian ₅ , J L Tokar ₆ , J B Samarasena ₇ , N El Hage Chehade ₇ , J Lee ₇ , K Chang ₇ , M Mizrahi ₈ , M Barawi ₉ , S Irani ₁₀ , S Friedland ₁₁ , P Korc ₁₂ , A A Aadam ₁₃ , M A Al-Haddad ₁₄ , T E Kowalski ₁₅ , A Novikov ₁₅ , G Smallfield ₁₆ , G G Ginsberg ₁₇ , V M Oza ₁₈ , D Panuu ₁₉ , N Fukami ₂₀ , H Pohl ₂₁ , Michael Lajin ₂₂ , N A Kumta ₂₃ , S J Tang ₂₄ , Y M Naga ₂₄ , S K Amateau ₂₅ , G O I Brewer ₁ , V Kumbhari ₁ , R Sharaiha ₅ , Mouen A Khashab _{1,

26}

Affiliation

Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA.
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA, USA.
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA.
Department of Gastroenterology, University of Washington, Seattle, WA, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Fox Chase Cancer Center, Philadelphia, PA, USA.
H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, CA, USA.
Department of Internal Medicine, Division of Gastroenterology, Center for Advanced Endoscopy, University of South Alabama, Mobile, AL, USA.
Division of Gastroenterology and Hepatology, St. John Hospital and Medical Center, Detroit, MI, USA.
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
Department of Medicine, Division of Gastroenterology, Hoag Hospital, Newport Beach, CA, USA.
Division of Gastroenterology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Thomas Jefferson University, Philadelphia, PA, USA.
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.
Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Division of Gastroenterology and Hepatology, University of South Carolina, Greenville, SC, USA.
McLeod Regional Medical Center, Florence, SC, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
VA White River Junction, White River Junction, VT, USA.
SHARP Grossmont Hospital, La Mesa, CA, USA.
Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Division of Gastroenterology, University of Minnesota, Minneapolis, MN, USA.
Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Bldg, 1800 Orleans Street, Suite 7125G, Baltimore, MD, 21287, USA.

Abstract

Background

Introduction of the full-thickness resection device (FTRD) has allowed endoscopic resection of difficult lesions such as those with deep wall origin/infiltration or those located in difficult anatomic locations. The aim of this study is to assess the outcomes of the FTRD among its early users in the USA.

Methods

Patients who underwent endoscopic full-thickness resection (EFTR) for lower gastrointestinal tract lesions using the FTRD at 26 US tertiary care centers between 10/2017 and 12/2018 were included. Primary outcome was R0 resection rate. Secondary outcomes included rate of technical success (en bloc resection), achievement of histologic full-thickness resection (FTR), and adverse events (AE).

Results

A total of 95 patients (mean age 65.5 ± 12.6 year, 38.9% F) were included. The most common indication, for use of FTRD, was resection of difficult adenomas (non-lifting, recurrent, residual, or involving appendiceal orifice/diverticular opening) (66.3%), followed by adenocarcinomas (22.1%), and subepithelial tumors (SET) (11.6%). Lesions were located in the proximal colon (61.1%), distal colon (18.9%), or rectum (20%). Mean lesion diameter was 15.5 ± 6.4 mm and 61.1% had a prior resection attempt. The mean total procedure time was 59.7 ± 31.8 min. R0 resection was achieved in 82.7% while technical success was achieved in 84.2%. Histologically FTR was demonstrated in 88.1% of patients. There were five clinical AE (5.3%) with 2 (2.1%) requiring surgical intervention.

Conclusions

Results from this first US multicenter study suggest that EFTR with the FTRD is a technically feasible, safe, and effective technique for resecting difficult colonic lesions.

中文翻译：

关于使用全厚度切除装置治疗困难的结肠病变的大型多中心研究

摘要

背景

引入全厚度切除装置（FTRD）使得可以在内窥镜下切除困难的病灶，例如具有深壁起源/浸润的病灶或位于困难的解剖部位的病灶。这项研究的目的是评估FTRD在美国的早期用户中的成果。

方法

包括在10/2017年至12/2018年之间在美国26个三级护理中心使用FTRD对下消化道病变进行内镜全层切除（EFTR）的患者。主要结局为R0切除率。次要结果包括技术成功率（整块切除），组织学全层切除（FTR）和不良事件（AE）的实现。

结果

总共包括95名患者（平均年龄65.5±12.6岁，F 38.9％）。使用FTRD的最常见指征是切除困难的腺瘤（不提起，复发，残留或累及阑尾孔/憩室开口）（66.3％），其次是腺癌（22.1％）和上皮下肿瘤（SET））（11.6％）。病变位于近端结肠（61.1％），远端结肠（18.9％）或直肠（20％）。平均病灶直径为15.5±6.4毫米，有61.1％的患者曾进行过切除手术。平均总手术时间为59.7±31.8分钟。R0切除率为82.7％，技术成功率为84.2％。在组织学上FTR在88.1％的患者中得到证实。有5例临床AE（5.3％），其中2例（2.1％）需要手术干预。