Adverse events of endoscopic full-thickness resection: results from the German and Dutch nationwide colorectal FTRD registry

Endoscopic full-thickness resection (eFTR) is emerging as a minimally invasive alternative to surgery for complex colorectal lesions. Previous studies have demonstrated favorable safety results; however, large studies representing a generalizable estimation of adverse events (AEs) are lacking. Our a...

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Published in:	Gastrointestinal endoscopy Vol. 97; no. 4; pp. 780 - 789.e4
Main Authors:	Zwager, Liselotte W., Mueller, Julius, Stritzke, Bettina, Montazeri, Nahid S.M., Caca, Karel, Dekker, Evelien, Fockens, Paul, Schmidt, Arthur, Bastiaansen, Barbara A.J., Albers, D., Beaumont, H., Bekkering, F.C., Bielich, A., Boonstra, J.J., ter Borg, F., Bos, P.R., Bulte, G.J., Caselitz, M., Denzer, U., Frieling, T., Gielisse, E.A.R., Glas, A., Glitsch, A., Hasberg, S., Hazen, W.L., Hofmann, C., Houben, M.H.M.G., ten Hove, W.R., Hübner, G., Kähler, G., Kirchner, T., Knoll, M., Lorenz, A., Meier, B., Mundt, M.W., Nagengast, W.B., Perk, L.E., Quispel, R., Rando Munoz, F.J., Repp, M., de Ridder, R.J.J., Rietdijk, S.T., Scholz, D., Schreuder, R.M., Schwartz, M.P., Seerden, T.C.J., van der Sluis, H., van der Spek, B.W., Straathof, J.W.A., Terhaar sive Droste, J.S., Triller, C., Vlug, M.S., van de Vrie, W., Wagner, A., Walter, B., Wallstabe, I., Wannhoff, A., Weusten, B.L.A.M., de Wijkerslooth, T.R., Wilhelm, M., Wolters, H.J., Zervoulakos, P.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2023
Subjects:	Appendicitis Colorectal Neoplasms - pathology Colorectal Neoplasms - surgery Endoscopic Mucosal Resection - methods Endoscopy Humans Retrospective Studies Treatment Outcome OTSC eFTR FTRD OR AE CI SAE ESD IQR
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Summary:	Endoscopic full-thickness resection (eFTR) is emerging as a minimally invasive alternative to surgery for complex colorectal lesions. Previous studies have demonstrated favorable safety results; however, large studies representing a generalizable estimation of adverse events (AEs) are lacking. Our aim was to provide further insight in AEs after eFTR. Data from all registered eFTR procedures in the German and Dutch colorectal full-thickness resection device registries between July 2015 and March 2021 were collected. Safety outcomes included immediate and late AEs. Of 1892 procedures, the overall AE rate was 11.3% (213/1892). No AE-related mortality occurred. Perforations occurred in 2.5% (47/1892) of all AEs, 57.4% (27/47) of immediate AEs, and 42.6% (20/47) of delayed AEs. Successful endoscopic closure was achieved in 29.8% of cases (13 immediate and 1 delayed), and antibiotic treatment was sufficient in 4.3% (2 delayed). The appendicitis rate for appendiceal lesions was 9.9% (13/131), and 46.2% (6/13) could be treated conservatively. The severe AE rate requiring surgery was 2.2% (42/1892), including delayed perforations in .9% (17/1892) and immediate perforations in .7% (13/1892). Delayed perforations occurred between days 1 and 10 (median, 2) after eFTR, and 58.8% (10/17) were located on the left side. Other severe AEs were appendicitis (.4%, 7/1892), luminal stenosis (.1%, 2/1892), delayed bleeding (.1%, 1/1892), pain after eFTR close to the dentate line (.1%, 1/1892), and grasper entrapment in the clip (.1%, 1/1892). Colorectal eFTR is a safe procedure with a low risk for severe AEs in everyday practice and without AE-related mortality. These results further support the position of eFTR as an established minimally invasive technique for complex colorectal lesions.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0016-5107 1097-6779
DOI:	10.1016/j.gie.2022.11.005