Meta-Analysis of Full-Thickness Resection in the Colorectum
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Meta-Analysis of Full-Thickness Resection in the Colorectum

Douglas K. Rex, MD, MASGE, reviewing Dolan RD, et al. Gastrointest Endosc 2021 Oct 7.

In a meta-analysis of 14 studies of colorectal endoscopic full-thickness resection (EFTR) involving 1936 patients, 76% of lesions were in the colon and the remainder in the rectum. Mean procedure time was 45 minutes, and pooled technical success was 87.6%, with R0 resection of 78.8%. The recurrence rate was 12.6%, and adverse events occurred in 12.2%. Adverse events included perforation (4.4%), postpolypectomy syndrome (1.7%), appendicitis after resection of appendiceal lesions (11.5%), and need for surgery after EFTR (5.5%).

Subgroup analysis showed that the R0 resection rate was lower (odds ratio [OR], 0.3) and the adverse event rate higher (OR, 3.5) for lesions >20 mm.

Douglas K. Rex, MD, FASGE

COMMENT

EFTR in the colorectum has a considerably shorter learning curve than ESD and provides an outstanding histologic specimen. However, the perforation risk is real, which must be considered for en bloc resection of lesions ≤30 mm, especially when other options (EMR, particularly underwater EMR) are available at a much lower complication rate and technically faster to perform. For lesions ˃30 mm, ESD is the main option when en bloc resection seems essential.

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)

Dolan RD, Bazarbashi AN, McCarty TR, Thompson CC, Aihara H. Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis. Gastrointest Endosc 2021 Oct 7. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.09.039)

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