Rescue hybrid endoscopic approaches for difficult colorectal polyps: The Greek experience

 

Aims Hybrid approaches of full-thickness resection device (FTRD; Ovesco Endoscopy,Tuebingen, Germany) and conventional techniques (EMR,ESD) have enabled the removal of difficult fibrotic adenomas with a “non-lifting” sign. We present a cohort of 10 patients treated with EMR+FTRD or ESD+FTRD as rescue hybrid endoscopic techniques for difficult colorectal polyps.

Methods In all cases, the resection of polyps was unfeasible with conventional procedures (EMR,ESD). Retrospective analysis of the data included technical success, clinical success, R0 resection, histological confirmation of margin-free resection, adverse events (AE) and endoscopic follow-up. All the patients underwent follow-up endoscopy in 6 and 12 months.

Results All resections (100%, 7 EMR+FTRD and 3 ESD+FTRD) were macroscopically complete with confirmed full-thickness resection. Clinical and technical success were achieved in all cases, except for one patient with severe diverticulitis and fibrosis, where the FTRD system could not be passed through the sigmoid colon. The mean lesion size in EMR+FTRD group (33.6 mm; range, 45-20 mm) was larger compared with the ESD+FTRD one (26.2 mm; range, 30-22 mm). Three of 7 patients treated with EMR+FTRD were histologically diagnosed with infiltrative adenocarcinomas (pT1bSM1-SM2) with clear margins. The majority of patients (90%) remained hospitalized for 1-3 post-endoscopy days. Follow-up endoscopy was available in all patients with no recurrence observed in 6-month and 12-month endoscopy.

Conclusions Hybrid procedures seem to be safe and effective treatments for complex colorectal lesions not amenable to EMR and ESD alone.

Publication History

Article published online:
14 April 2023

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