Division of Gastroenterology and Hepatology, Zurich University Hospital, Zurich, Switzerland.
Surg Endosc. 2018 Jan;32(1):289-299. doi: 10.1007/s00464-017-5676-9. Epub 2017 Jun 29.
Classic endoscopic resection techniques (EMR and ESD) are limited to mucosal lesions. In the case of deeper growth into the gut wall and anatomic sites prone to perforation, the novel full-thickness resection device (FTRD) opens a new dimension of possibilities for endoscopic resection.
Sixty patients underwent endoscopic full-thickness resection (eFTR) at our institution. Safety, learning curve, R0 resection rate, and clinical outcome were studied.
In 97% (58/60) of the interventions, the FTRD-mounted endoscope reached the previously marked lesion and eFTR was performed (technical success). Full-thickness resection was achieved in 88% of the cases, with an R0 resection on histological examination in 79%. The clinical success rate based on follow-up histology was even higher (88%). Adverse events occurred in 7%. Appendicitis of the residual cecal appendix after eFTR of an adenoma arising in the appendix led to the only post-eFTR surgery (1/58, 2%). Minor bleeding at the eFTR site (2/58, 3%) and an eFTR performed accidently without proper prior deployment of the OTSC (1/58, 2%) were successfully treated endoscopically. There was no secondary perforation or eFTR-associated mortality.
After specific training, eFTR is a feasible, safe, and promising all-in-one endoscopic resection technique. Our data show that eFTR allows complete resection of lesions affecting layers of the gut wall beneath the mucosa with a low risk of adverse events. However, our preliminary results need to be confirmed in larger, controlled studies.
经典的内镜切除技术（EMR 和 ESD）仅限于黏膜病变。对于更深层生长到肠壁和容易穿孔的解剖部位，新型全层切除装置（FTRD）为内镜切除开辟了一个新的可能性维度。
我们机构对 60 名患者进行了内镜全层切除术（eFTR）。研究了安全性、学习曲线、R0 切除率和临床结果。
在 97%（58/60）的干预中，FTRD 安装的内镜到达了先前标记的病变部位并进行了 eFTR（技术成功）。88%的病例实现了全层切除，组织学检查 R0 切除率为 79%。基于随访组织学的临床成功率甚至更高（88%）。7%发生不良事件。eFTR 切除阑尾腺瘤后残余阑尾的阑尾炎导致唯一的 post-eFTR 手术（1/58，2%）。eFTR 部位轻微出血（2/58，3%）和未经适当预先部署 OTSC 意外进行的 eFTR（1/58，2%）均经内镜成功治疗。没有发生继发性穿孔或与 eFTR 相关的死亡率。
经过特定培训，eFTR 是一种可行、安全且有前途的一体式内镜切除技术。我们的数据表明，eFTR 允许完整切除影响黏膜下层肠壁层的病变，不良事件的风险较低。然而，我们的初步结果需要在更大的对照研究中得到证实。
