Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Surg Res. 2022 Dec;280:440-449. doi: 10.1016/j.jss.2022.07.019. Epub 2022 Aug 30.
Endoscopic full-thickness resection (EFTR) with an over-the-scope full-thickness resection device is a relatively new technique for the resection of colorectal lesions. Multiple centers have published the results of case series and observational cohorts regarding the use of this technique for managing difficult polyps. This study aims to aggregate the results of these studies to determine the effectiveness and safety of this technique in the resection of these technically challenging colonic lesions.
MEDLINE, EMBASE, and CENTRAL were searched. Articles were included if they reported technical success rate for EFTR of colonic lesions. The primary outcome was technical success rate and secondary outcomes included rate of R0 resection and overall 30-d morbidity. DerSimonian and Laird random-effects meta-analysis of proportions was used to generate effect sizes for pooled outcomes.
From 2211 citations, 21 studies with 1539 patients (mean age 67.2 y, 39.5% female) undergoing 1551 procedures were included. Difficult to resect benign lesions were the most commonly excised lesions (hyperplastic: 35.9%; adenomas: 30.2%), followed by T1 adenocarcinomas (25.6%) and neuroendocrine tumors (6.1%). Technical success rate was 89% (95% confidence interval [CI] 87-92), and R0 resection rate was 79% (95% CI 76-82). Mean procedure time was 53.5 min and mean specimen size was 17.5 mm. Overall 30-d morbidity was 11% (95% CI 7-13), and incidences of perforation and postpolypectomy bleeding were 2% (95% CI 1-2) and 5% (95% CI 3-7), respectively. Lesion recurrence at 3-mo follow-up was 8%.
EFTR requires further large sample size, comparative studies with reporting of long-term oncologic data. However, preliminary findings indicate that it is a safe and effective technique with high rates of technical success and acceptable rates of R0 resection when employed by experienced endoscopists for high-risk colonic lesions.
内镜全层切除术（EFTR）联合内镜全层切除装置是一种针对结直肠病变的全新切除技术。多个中心已经发表了关于该技术在处理困难性息肉中的应用的病例系列和观察队列的研究结果。本研究旨在汇总这些研究的结果，以确定该技术在切除这些技术挑战性结直肠病变中的有效性和安全性。
检索 MEDLINE、EMBASE 和 CENTRAL。如果文章报告了 EFTR 治疗结直肠病变的技术成功率，则将其纳入研究。主要结局为技术成功率，次要结局包括 R0 切除率和总体 30 天发病率。采用 DerSimonian 和 Laird 随机效应荟萃分析比例，生成汇总结局的效应大小。
从 2211 条引文中共纳入 21 项研究，共纳入 1539 例患者（平均年龄 67.2 岁，39.5%为女性），共行 1551 例手术。切除的最常见病变是难以切除的良性病变（增生性病变：35.9%；腺瘤：30.2%），其次是 T1 腺癌（25.6%）和神经内分泌肿瘤（6.1%）。技术成功率为 89%（95%置信区间 [CI] 87-92），R0 切除率为 79%（95% CI 76-82）。平均手术时间为 53.5 分钟，平均标本大小为 17.5 毫米。总体 30 天发病率为 11%（95% CI 7-13），穿孔和息肉切除后出血的发生率分别为 2%（95% CI 1-2）和 5%（95% CI 3-7）。3 个月随访时的病变复发率为 8%。
EFTR 需要进一步扩大样本量，并进行与长期肿瘤学数据报告相关的对照研究。然而，初步研究结果表明，对于经验丰富的内镜医生来说，对于高危结直肠病变，该技术是一种安全有效的技术，具有较高的技术成功率和可接受的 R0 切除率。
