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Response

      We thank Wang and Li
      • Wang Y.
      • Li P.
      No efficacy without comparison.
      for their valuable feedback and perspective regarding our recent endoscopic full-thickness resection (EFTR) systematic review and meta-analysis.
      • Dolan R.D.
      • Bazarbashi A.N.
      • McCarty T.R.
      • et al.
      Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis.
      In that systematic review and meta-analysis, we included a total of 14 studies and 1936 patients specifically evaluating the use of EFTR for colorectal lesions. The letter-writers are correct that this article expanded on the number of included studies and patients compared with the previous work by Li et al.
      • Li P.
      • Ma B.
      • Gong S.
      • et al.
      Efficacy and safety of endoscopic full-thickness resection in the colon and rectum using an over-the-scope device: a meta-analysis.
      Similarly to this prior meta-analysis, our results found EFTR to be highly effective. Importantly, our work included a meta-regression and demonstrated that EFTR may be less effective for lesions >20 mm, with a decreased rate of R0 resection (OR 0.3; 95% CI, 0.2-0.6) and a higher overall rate of procedure-associated adverse events (OR 3.5; 95% CI, 1.8-7.2).
      With regard to study selection and inclusion, this systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines.
      • Stroup D.F.
      • Berlin J.A.
      • Morton S.C.
      • et al.
      Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
      ,
      • Liberati A.
      • Altman D.G.
      • Tetzlaff J.
      • et al.
      The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
      Studies evaluating non-EFTR techniques (including noncomparator studies) were excluded from this analysis. In reference to the Valli et al
      • Valli P.V.
      • Mertens J.
      • Bauerfeind P.
      Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD®).
      study suggested by Wang and Li,
      • Wang Y.
      • Li P.
      No efficacy without comparison.
      that study was specifically excluded because colorectal-specific outcomes could not be extrapolated from the study (ie, the inclusion of upper GI tract lesions as well). Furthermore, patients in this study were included (ie, overlapping or duplication of patient data) in the study by Meier et al.
      • Meier B.
      • Stritzke B.
      • Kuellmer A.
      • et al.
      Efficacy and safety of endoscopic full-thickness resection in the colorectum: results from the German Colonic FTRD Registry.
      Therefore, the decision was made to specifically exclude this from the cumulative analysis.
      The purpose of this cumulative meta-analysis was to summarize all available literature regarding EFTR for colorectal lesions. Through a literature search and manuscript inclusion, many of the studies were retrospective in nature, single-centered, and single-arm with no comparison to other modalities. We completely agree that high-quality comparator studies are needed. Randomized trials and prospective studies comparing this EFTR technique with other endoscopic strategies (endoscopic submucosal dissection or piecemeal EMR) are warranted and should be performed.

      Disclosure

      Dr Thompson is a consultant for and recipient of research support from Apollo Endosurgery, GI Dynamics, and Olympus/Spiration; a recipient of research support from Aspire Bariatrics; a general partner in BlueFlame Healthcare Venture Fund; a consultant for Boston Scientific and Covidien/Medtronic; a board member of EnVision Endoscopy; a consultant for and advisory board member of Fractyl; a holder of ownership interest in GI Windows; a recipient of research support from Spatz; and a consultant for, advisory board member of, and recipient of research support from USGI Medical. Dr Aihara is a consultant for Olympus America, Boston Scientific, Fujifilm Medical Systems, Auris Health, Lumendi, Medtronic, ConMed, and 3D Matrix. The remaining authors disclosed no financial relationships.

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        • Li P.
        No efficacy without comparison.
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        • et al.
        Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis.
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        • Li P.
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        Efficacy and safety of endoscopic full-thickness resection in the colon and rectum using an over-the-scope device: a meta-analysis.
        Surg Endosc. 2021; 35: 249-259
        • Stroup D.F.
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        • Liberati A.
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        Ann Intern Med. 2009; 151: W65-W94
        • Valli P.V.
        • Mertens J.
        • Bauerfeind P.
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        Surg Endosc. 2018; 32: 289-299
        • Meier B.
        • Stritzke B.
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        Efficacy and safety of endoscopic full-thickness resection in the colorectum: results from the German Colonic FTRD Registry.
        Am J Gastroenterol. 2020; 115: 1998-2006

      Linked Article

      • No efficacy without comparison
        Gastrointestinal EndoscopyVol. 96Issue 1
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          We read with interest the article by Dolan et al1 in which endoscopic full-thickness resection (EFTR) for colorectal lesions was evaluated. The authors reported that EFTR for colorectal lesions is an effective modality with high technical success and a favorable R0 resection rate. Because their findings are important to current practice, several questions deserve attention.
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