Update on Adverse Events With Colorectal Endoscopic Full-thickness Resection

This study updates complication rates associated with the full-thickness resection device (FTRD) from a combined Dutch and German registry, with 1892 procedures performed between July 2015 and March 2021.

The overall perforation rate was 2.5%, with 57.4% immediate (n=27) and 42.6% delayed (n=20) perforations. Endoscopic closure of perforation was successful in 30% of cases, of which 13 were immediate perforations and one was a delayed perforation.

In 12 of the immediate perforations, the closure was performed with an over-the-scope clip. Immediate perforations could be related to sigmoid rupture from instrument passage, incorrect sequence of clip firing, or clip malfunction. There were 42 severe adverse events requiring surgery, and there was no mortality related to complications. Two surgeries were for severe stenosis, 1 for severe bleeding, 1 for severe pain after resection of a lesion near the dentate line, and 1 for the grasper entrapped in the clip.

Some of the data were incomplete regarding prior appendectomies. According to the Dutch registry, appendicitis without a prior appendectomy occurred in 7 of 33 patients (21.2%) undergoing resection of appendiceal lesions, and 5 of 7 were treated surgically.

There were a total of 65 German centers and 20 Dutch centers involved in the study, with no difference in complications between high- and low-volume centers. The total adverse event rate was 11.3% (n=213), which included the most common events, immediate and delayed bleeding (n=117; of which only one case was a severe adverse event), and 15 cases of postpolypectomy syndrome, which all responded to conservative therapy.