Combined EMR and Full-Thickness Resection for Large Nonlifting Colorectal Adenomas
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Combined EMR and Full-Thickness Resection for Large Nonlifting Colorectal Adenomas

Douglas K. Rex, MD, MASGE, reviewing Meier B, et al. Gastrointest Endosc 2023 Mar 27.

Endoscopic submucosal dissection (ESD) is an option for scarred, large colorectal adenomas that do not lift well and/or contain a suspicious area of an advanced lesion. Endoscopic mucosal resection (EMR) followed by endoscopic full-thickness resection (EFTR), however, is faster and easier than ESD for these types of lesions. The current description of this hybrid-EFTR approach includes 75 patients and is the largest series yet reported. 

The mean lesion size was 36.5 mm, and two-thirds were right-sided. Six lesions involved the appendiceal orifice. Most of the lesions had been previously treated in some fashion. Technical success was 100%, although, in two cases, the entire lesion could not be pulled into the cap of the full-thickness resection device. 

The mean procedure time was 83.6 minutes, with T1 cancer identified in 12 cases, and 8 of these had subsequent surgery for adverse histologic features. Among the adverse features included in the study was deep submucosal invasion, and one patient required surgery for appendicitis. 

There were 70 patients with follow-up, with an 11.4% rate of residual lesion, of which all but one were treated by repeat EFTR.

Douglas K. Rex, MD, FASGE

COMMENT

This large report of hybrid-EFTR confirms a high technical success rate, fast procedural times, low adverse event rates, and a low recurrence rate. Hybrid-EFTR can be considered one acceptable approach to large laterally spreading colorectal lesions with a smaller (<20 mm) focal area that is scarred down or suspicious for cancer.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Meier B, Elsayed I, Seitz N, Wannhoff A, Caca K. Efficacy and safety of combined endoscopic mucosal resection and endoscopic full-thickness resection (Hybrid-EFTR) for large non-lifting colorectal adenoma. Gastrointest Endosc 2023 Mar 27. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.03.020)

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