Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
Gastrointest Endosc. 2023 Sep;98(3):405-411. doi: 10.1016/j.gie.2023.03.020. Epub 2023 Mar 27.
Endoscopic full-thickness resection (EFTR) with a full-thickness resection device (FTRD) has become the standard technique for selected nonlifting colorectal adenomas, but tumor size is the major limitation. However, large lesions might be approached in combination with EMR. Herein, we report the largest single-center experience to date of combined EMR and EFTR (hybrid EFTR) in patients with large (≥25 mm) nonlifting colorectal adenomas not amenable to EMR or EFTR alone.
This is a single-center retrospective analysis of consecutive patients who underwent hybrid EFTR of large (≥25 mm) nonlifting colorectal adenomas. Outcomes of technical success (successful advancement of the FTRD with consecutive successful clip deployment and snare resection), macroscopic complete resection, adverse events, and endoscopic follow-up were evaluated.
Seventy-five patients with nonlifting colorectal adenomas were included. Mean lesion size was 36.5 mm (range, 25-60 mm), and 66.6% were located in the right side of the colon. Technical success was 100% with macroscopic complete resection in 97.3%. Mean procedure time was 83.6 minutes. Adverse events occurred in 6.7%, leading to surgical therapy in 1.3%. Histology revealed T1 carcinoma in 16%. Endoscopic follow-up was available in 93.3% (mean follow-up time, 8.1 months; range, 3-36) and showed no signs of residual or recurrent adenoma in 88.6%. Recurrence (11.4%) was treated endoscopically.
Hybrid EFTR is safe and effective for advanced colorectal adenoma that cannot be approached by EMR or EFTR alone. Hybrid EFTR expands the indication of EFTR substantially in selected patients.
内镜全层切除术（EFTR）联合全层切除装置（FTRD）已成为有选择的非抬举性结直肠腺瘤的标准技术，但肿瘤大小是主要限制因素。然而，对于较大的病变，可以结合 EMR 进行处理。在此，我们报告了迄今为止最大的单中心经验，即对不能单独进行 EMR 或 EFTR 处理的较大（≥25mm）非抬举性结直肠腺瘤患者联合进行 EMR 和 EFTR（混合 EFTR）。
这是一项对连续接受混合 EFTR 治疗的较大（≥25mm）非抬举性结直肠腺瘤患者的单中心回顾性分析。评估技术成功（FTRD 成功推进，连续成功夹闭和圈套切除）、宏观完全切除、不良事件和内镜随访的结果。
共纳入 75 例非抬举性结直肠腺瘤患者。平均病变大小为 36.5mm（范围 25-60mm），66.6%位于结肠右侧。技术成功率为 100%，宏观完全切除率为 97.3%。平均手术时间为 83.6 分钟。不良事件发生率为 6.7%，导致手术治疗的为 1.3%。组织学显示 T1 癌 16%。93.3%（平均随访时间 8.1 个月，范围 3-36 个月）可进行内镜随访，88.6%未发现残留或复发性腺瘤的迹象。复发（11.4%）采用内镜治疗。
混合 EFTR 是安全有效的，适用于不能单独通过 EMR 或 EFTR 处理的进展期结直肠腺瘤。混合 EFTR 大大扩展了 EFTR 在选定患者中的适应证。
