Authors C. SNAUWAERT (1), P. DEPREZ (2), H. PIESSEVAUX (2) / [1] AZ Sint-Jan Brugge-Oostende, Brugge, Belgium, Hepatology and Gastroenterology, [2] Cliniques universitaires Saint-Luc, Brussels, Belgium, Hepatology and Gastroenterology Introduction Endoscopic Full Thickness Resection (EFTR) using the full thickness resection device (FTRD) enables en-bloc resection of lesions involving or originating from the deeper layers of the intestinal wall which would otherwise require surgical removal. We present the first Belgian EFTR-series using the FTRD and delineate feasibility and early outcomes of this procedure. Aim To assess efficacy, safety and early outcomes of EFTR using the FTRD and identify possible risk factors for technical difficulty. Methods Retrospective analysis of a prospectively collected database of patients scheduled for EFTR using the FTRD system between January 2015 - November 2018. Main endpoints were technical success, specimen size, R0 resection, and adverse events. Results 23 consecutive patients were identified across two centers (10/13). Median age of patients was 71 years (IQR 34-78). Lesions were located throughout the gastrointestinal tract: ileal pouch (1), appendix base adenoma (1), caecum (2), ascending colon (2), hepatic flexure (3), transverse colon (1), splenic flexure (3), descending colon (3), sigmoid colon (3), rectum (3) and gastric antrum (1). Indications for EFTR included gastric submucosal neuro-endocrine tumor (NET) (1), residual rectal NET after endoscopic resection (1), appendix base adenoma (1), central adherence (fibrosis) during endoscopic submucosal dissection (ESD) at the splenic flexure (1), earlier attempt at endoscopic mucosal resection (EMR) with non-lifting sign (4), residual adenomatous tissue after EMR (4), incomplete endoscopic resection of a malignant polyp (3) and endoscopic findings suggestive of deep submucosal invasion (8). In all patients the target lesion could be reached with the FTRD. Successful EFTR was achieved in 96% of patients (22/23). Median specimen size was 22.4 mm (range 11-35). R0 resection was achieved in 87% of patients (20/22). Post-procedure complications occurred in 2 patients of which 1 delayed bleeding (successfully endoscopically treated) and 1 patient required surgery for intra-procedural perforation salvage (FTRD maldeployment). Two FTRD procedures were performed under conscious sedation (midazolam/alfentanil) without any complications. The majority of lesions (14/22) contained advanced histologic features: high-grade dysplasia / intramucosal carcinoma (4), pT1 (9) and one pT2 lesion. In 3 of these patients, additional surgery was performed (unfavorable histopathology; risk of lymph node metastasis) and no residual tumor or lymph node metastasis could be detected. Conclusions EFTR using the FTRD appears to be feasible and efficacious in the resection of lesions of up to 30 - 35 mm in diameter and may offer a minimally invasive approach for radical resection of these lesions as an alternative to surgery in selected patients. Safety is a concern and more long-term follow-up data are awaited.
