Endoscopic full-thickness resection for the treatment of local residual neoplastia in the colon – an analysis of 19 cases

Czech version

Authors: P. Falt ^1,2; T. Hucl ³; P. Fojtík ⁴; P. Drastich ³; J. Martínek ³; R. Andělová ⁵; L. Voska ⁶; J. Špičák ³; O. Urban ^1,2
Authors‘ workplace: II. interní klinika – gastroenterologie a geriatrie LF UP a FN Olomouc ¹; Katedra interních oborů, LF UK v Hradci Králové ²; Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha ³; Centrum péče o zažívací trakt, Vítkovická nemocnice a. s., Ostrava ⁴; Oddělení patologie, Nemocnice Nový Jičín a. s. ⁵; Pracoviště klinické a transplantační patologie, Transplantcentrum, IKEM, Praha ⁶
Published in: Gastroent Hepatol 2018; 72(3): 206-211
Category:
doi: https://doi.org/10.14735/amgh2018206

Overview

Introduction:
Endoscopic full-thickness resection (FTR) is a novel endoscopic technique that allows transmural resection of the colonic wall. Limited data suggest that FTR is efficacious and safe for the management of local residual neoplasia (LRN). Standard endoscopic treatment of LRN is usually complicated by scarring and non-lifting sign caused by a previous endoscopic resection.

Methods:
We prospectively evaluated patients treated with FTR for difficult LRN after at least one session of endoscopic treatment in two tertiary endoscopic centers between June 2016 and January 2018. Primary outcomes were technical success rate, R0, and curative resection rate and occurrence of complications.

Results:
Nineteen patients with LRN (age 69.2 ± 10.5 years; 79% males) were treated between June 2016 and January 2018. Six cases of LRN were localized in the rectum and 13 cases in the colon. Mean size of the lesions was 16 (8–25) mm. There were four cases of low-grade dysplasia adenoma, 13 cases of high-grade dysplasia adenoma, one intramucosal adenocarcinoma, and one adenocarcinoma with superficial submucosal invasion. FTR was technically successful in 90% (17/19) of cases. R0 and concurrently curative resection was achieved in 74% (14/19) of cases. In 2 patients with large LRNs, a combination of endoscopic mucosal resection and FTR was successfully used. Complications were noted in 11% (2/19) of cases, 1 patient suffered from delayed bleeding, and one patient from acute appendicitis, but both responded to conservative treatment. Conclusion: In our series of 19 patients with difficult LRN, FTR was technically feasible in 90% of cases. Both R0 and curative resection were achieved in 74% of cases. Mild complications not requiring surgery occurred in 11% of patients.

Key words:
local residual neoplasia – endoscopic full-thickness resection – endoscopic mucosal resection – colorectal cancer

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted: 16. 4. 2018

Accepted: 12. 5. 2018

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