Download PDF
Z Gastroenterol 2022; 60(05): 741-752
DOI: 10.1055/a-1310-4320
Originalarbeit

Systematic review and meta-analysis on effectiveness and safety of the full-thickness resection device (FTRD) in the colon

Metaanalyse zur endoskopischen Vollwandresektion im Kolon
Andreas Wannhoff
  Department of Internal Medicine I, Hospital Ludwigsburg, Ludwigsburg, Germany
,
Benjamin Meier
  Department of Internal Medicine I, Hospital Ludwigsburg, Ludwigsburg, Germany
,
Karel Caca
  Department of Internal Medicine I, Hospital Ludwigsburg, Ludwigsburg, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Endoscopic full-thickness resection (EFTR) has expanded the possibilities of endoscopic resection. The full-thickness resection device (FTRD, Ovesco Endoscopy, Tübingen, Germany) combines a clip-based defect closure and snare resection in a single device.

Methods Systematic review and meta-analysis on effectiveness and safety of the FTRD in the colon.

Results A total of 26 studies (12 published as full-text articles and 14 conference papers) with 1538 FTRD procedures were included. The pooled estimate for reaching the target lesion was 96.1 % (95 % confidence interval [95 % CI]: 94.6–97.1) and 90.0 % (95 % CI: 87.0–92.3) for technically successful resection. Pooled estimate of histologically complete resection was 77.8 % (95 % CI: 74.7–80.6). Adverse events occurred at a pooled estimate rate of 8.0 % (95 % CI: 5.8–10.4). Pooled estimates for bleeding and perforation were 1.5 % (95 % CI: 0.3–3.3) and 0.3 % (95 % CI: 0.0–0.9), respectively. The rate for need of emergency surgery after FTRD was 1.0 % (95 % CI: 0.4–1.8).

Conclusion The use of the FTRD in the colon shows very high rates of technical success and complete resection (R0) as well as a low risk of adverse events. Emergency surgery after colonic FTRD resection is necessary in single cases only.

Zusammenfassung

Hintergrund Die endoskopische Vollwandresektion erweitert die Möglichkeiten endoskopischer Resektionen. Sie basiert auf der Resektion der Läsion einerseits und dem sicheren Verschluss des Resektionsdefekts andererseits. Das Full-Thickness Resection Device (FTRD, Ovesco Endoscopy, Tübingen) vereint beide Schritte in einem Gerät. Typische Indikationen sind sogenannte schwierige oder Non-lifting-Adenome im Kolon.

Methodik Systematisches Review und Metaanalyse zur Effektivität und Sicherheit der endoskopischen Vollwandresektion im Kolon mit dem FTRD-System.

Ergebnisse Insgesamt wurden 26 Studien eingeschlossen, darunter 12 Volltextpublikationen und 14 Kongressbeiträge. Die Gesamtzahl der analysierten FTRD-Prozeduren betrug 1538. Die Zielläsion wurde mit einer Rate von 96,1 % (95 %-Konfidenzintervall (95 %-KI): 94,6–97,1) erreicht. Die Resektion war in 90,0 % (95 %-KI: 87,0–92,3) technisch erfolgreich. und eine R0-Resektion gelang mit einer Rate von 77,8 % (95 %-KI: 74,7–80,6). Komplikationen traten bei 8,0 % (95 %-KI: 5,8–10,4) der Prozeduren auf; die Rate der Nachblutungen und Perforationen lag bei 1,5 % (95 %-KI: 0,3–3,3) bzw. 0,3 % (95 %-KI: 0,0–0,9). Die Rate komplikationsbedingter Operationen betrug 1,0 % (95 %-KI: 0,4–1,8).

Schlussfolgerung Die endoskopische Vollwandresektion im Kolon mittels FTRD ist effektiv und sicher. Eine R0-Resektion gelingt in vielen Fällen, und insbesondere schwerwiegende Komplikationen mit der Notwendigkeit einer Notfalloperation sind sehr selten.

Key words

endoscopic full-thickness resection (EFTR) - full-thickness resection device (FTRD) - non-lifting adenoma - colorectal cancer - colonoscopy - polypectomy

Schlüsselwörter

Vollwandresektion - FTRD - Adenom - Kolonkarzinom - Koloskopie - Polypektomie


Publication History

Received: 05 June 2020

Accepted: 09 November 2020

Article published online:
29 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Wannhoff A, Caca K. Endoscopic full-thickness resection of early mucosal neoplasms. Tech Gastrointest Endosc 2019; 21: 13-18
    CrossrefPubMedGoogle Scholar
  • 2 Schmidt A, Meier B, Caca K. Endoscopic full-thickness resection: current status. World J Gastroenterol 2015; 21: 9273-9285
    CrossrefPubMedGoogle Scholar
  • 3 Bauder M, Schmidt A, Caca K. Non-exposure, device-assisted endoscopic full-thickness resection. Gastrointest Endosc Clin N Am 2016; 26: 297-312
    CrossrefPubMedGoogle Scholar
  • 4 Schurr MO, Baur FE, Krautwald M. et al. Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study. Surg Endosc 2015; 29: 2434-2441
    CrossrefPubMedGoogle Scholar
  • 5 Schmidt A, Bauerfeind P, Gubler C. et al. Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy 2015; 47: 719-725
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Bauder M, Schmidt A, Caca K. Endoscopic full-thickness resection of duodenal lesions-a retrospective analysis of 20 FTRD cases. United European Gastroenterol J 2018; 6: 1015-1021
    CrossrefPubMedGoogle Scholar
  • 7 Meier B, Schmidt A, Glaser N. et al. Endoscopic full-thickness resection of gastric subepithelial tumors with the gFTRD-system: a prospective pilot study (RESET trial). Surg Endosc 2020; 34: 853-860
    CrossrefPubMedGoogle Scholar
  • 8 Meier B, Caca K, Fischer A. et al. Endoscopic management of colorectal adenomas. Ann Gastroenterol 2017; 30: 592-597
    CrossrefPubMedGoogle Scholar
  • 9 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289
    CrossrefPubMedGoogle Scholar
  • 10 R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2020
    PubMedGoogle Scholar
  • 11 Viechtbauer W. Conducting meta-analyses in R with the metafor Package. J Stat Softw 2010; 36: 48
    CrossrefPubMedGoogle Scholar
  • 12 Balduzzi S, Rucker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health 2019; 22: 153-160
    CrossrefPubMedGoogle Scholar
  • 13 Krutzenbichler I, Dollhopf M, Lewerenz B. et al. Technischer Erfolg, Resektionsstatus sowie prozedurale Komplikationensrate der endoskopischen Vollwandresektion mittels “Full Thickness Resection Device” (FTRD)—Ergebnisse einer gepoolten Analyse aus verschiedener Kliniken. Z Gastroenterol 2019; 57: KV 431
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Zwager LW, Bronzwaer MES, van der Spek BW. et al. Endoscopic full-thickness resection of colorectal lesions—a dutch nationwide prospective cohort study. Endoscopy 2019; 51: OP331
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Andrisani G, Soriani P, Manno M. et al. Colo-rectal endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD®): a multicenter Italian experience. Dig Liver Dis 2019; 51: 375-381
    CrossrefPubMedGoogle Scholar
  • 16 Li P, Ma B, Gong S. et al. Effectiveness and safety of endoscopic full-thickness resection in the colon and rectum using an over-the-scope device: a meta-analysis. Surg Endosc 2020; DOI: 10.1007/s00464-020-07387-w.
    CrossrefPubMedGoogle Scholar
  • 17 Backes Y, Kappelle WFW, Berk L. et al. Colorectal endoscopic full-thickness resection using a novel, flat-base over-the-scope clip: a prospective study. Endoscopy 2017; 49: 1092-1097
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Aepli P, Criblez D, Baumeler S. et al. Endoscopic full thickness resection (EFTR) of colorectal neoplasms with the Full Thickness Resection Device (FTRD): clinical experience from two tertiary referral centers in Switzerland. United European Gastroenterol J 2018; 6: 463-470
    CrossrefPubMedGoogle Scholar
  • 19 Hu M, Rahman I, Ishaq S. et al. ADTH-01 Endoscopic full thickness resection in the colon: 3-year multicentre UK experience. Gut 2018; 67: A7
    PubMedGoogle Scholar
  • 20 Valli PV, Mertens J, Bauerfeind P. Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD®). Surg Endosc 2018; 32: 289-299
    CrossrefPubMedGoogle Scholar
  • 21 von Helden A, Hildenbrand R, Sido B. et al. Endoscopic full-thickness resection using an over-the-scope device for treatment of recurrent/residual colorectal neoplasia: a single-center case series. BMC Gastroenterol 2019; 19: 121
    CrossrefPubMedGoogle Scholar
  • 22 Uchima H, Barquero D, Esteban JM. et al. EFTR with OTSC in colorectum: what happens when the lesion is trapped in the over-the-scope-clip and is not resected. Endoscopy 2019; 51: ePP172
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Richter-Schrag HJ, Walker C, Thimme R. et al. [Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon]. Chirurg 2016; 87: 316-325
    CrossrefPubMedGoogle Scholar
  • 24 Le Baleur Y, Leblanc S, Pioche M. et al. Observatoire Francais de la resection transparietale per endoscopique par le systeme “FTRD” (Full Thickness Resection Device). Endoscopy 2018; 50: 000759
    PubMedGoogle Scholar
  • 25 Vitali F, Naegel A, Siebler J. et al. Endoscopic full-thickness resection with an over-the-scope clip device (FTRD) in the colorectum: results from a university tertiary referral center. Endosc Int Open 2018; 6: E98-E103
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Albrecht H, Raithel M, Braun A. et al. Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract. Tech Coloproctol 2019; 23: 957-963
    CrossrefPubMedGoogle Scholar
  • 27 Ichkhanian Y, Vosoughi K, Sharaiha RZ. et al. 716 non-exposure full-thickness resection of colonic lesions in the U.S.: the FTRD experience. Gastrointest Endosc 2019; 89: AB108
    CrossrefPubMedGoogle Scholar
  • 28 Kreutzer T, Walter B, Schmidt A. et al. Untersuchung des Appendizitis-Risiko nach endoskopischer Vollwandresektion von Adenomen im Bereich der Appendix mit dem FTRD-System. Z Gastroenterol 2018; 56: e377
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Bronzwaer MES, Bastiaansen BAJ, Koens L. et al. Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a prospective observational case study. Endosc Int Open 2018; 6: E1112-E1119
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Bourke MJ, Neuhaus H. Colorectal endoscopic submucosal dissection: when and by whom?. Endoscopy 2014; 46: 677-679
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Küllmer A, Mueller J, Caca K. et al. Endoscopic full-thickness resection for early colorectal cancer. Gastrointest Endosc 2019; 89: 1180-1189 e1181
    CrossrefPubMedGoogle Scholar
  • 32 Meier B, Caca K, Schmidt A. Hybrid endoscopic mucosal resection and full-thickness resection: a new approach for resection of large non-lifting colorectal adenomas (with video). Surg Endosc 2017; 31: 4268-4274
    CrossrefPubMedGoogle Scholar
  • 33 Sofia Yuen PY, Vareedayah AA, Skup M. et al. Tu1986 A novel hybrid technique using endoscopic mucosal resection (EMR) and endoscopic full-thickness resection (EFTR) for large colorectal neoplasms unresectable by emr alone. Gastrointest Endosc 2019; 89: AB643-AB644
    CrossrefPubMedGoogle Scholar
  • 34 Thomsen T, Gottschalk U, Ernst M. et al. Die endoskopische Vollwandresektion von Kolonpolypen mit dem full-thickness-resection-device (FTRD). Ein sicheres endoskopische Verfahren. Z Gastroenterol 2016; 54: KV098
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Altmann M, Langeloh L, Adam P. et al. Vollwandresektion mittels FTRD®-System – Erfahrungen in der Klinik Kösching. Z Gastroenterol 2017; 55: K10
    PubMedGoogle Scholar
  • 36 Pickartz T, Simon P, Aghdassi AA. et al. Endoskopische Vollwandresektion mit dem FTRD im klinischen Alltag, Single-Center-Erfahrung bei 17 Patienten. Z Gastroenterol 2017; 55: KV 472
    PubMedGoogle Scholar
  • 37 Braun A. Sa1897 Amyloidosis-diagnosis by endoscopic full-thickness resection (EFTR). Gastrointest Endosc 2018; 87: AB239
    CrossrefPubMedGoogle Scholar
  • 38 Falt P, Hucl T, Fojtik P. et al. Endoscopic full-thickness resection in the colon – first experience. Endoscopy 2018; 50: ePP012
    PubMedGoogle Scholar
  • 39 Mao de-Ferro S, Castela J, Pereira D. et al. Endoscopic full-thickness resection of colorectal lesions with the new FTRD system: single-center experience. GE Port J Gastroenterol 2019; 26: 235-241
    CrossrefPubMedGoogle Scholar
  • 40 Sferrazza S, Di Mitri R, Jovani M. et al. P.05.21 Endoscopic full-thickness resection (EFTR) in the colorectum using the over-the-scope device (FTRD system): an Italian case series. Dig Liver Dis 2019; 51: e193
    CrossrefPubMedGoogle Scholar
  • 41 Stathopoulos P, Gallmeier E, Gress TM. et al. Endoskopische Vollwandresektion (“endoscopic full-thickness resection”, eFTR) für kolorektale Läsionen – eine retrospektive Analyse von 38 konsekutiven Fällen. Z Gastroenterol 2019; 57: KV 432
    PubMedGoogle Scholar
  • 42 Velegraki M, Trikola A, Vasiliadis K. et al. Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece. Ann Gastroenterol 2019; 32: 482-488
    PubMedGoogle Scholar