Adverse events of endoscopic full-thickness resection: results from the German and Dutch nationwide colorectal FTRD registry

Published:November 18, 2022DOI:
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      Background and Aims

      Endoscopic full-thickness resection (eFTR) is emerging as minimally invasive alternative to surgery for complex colorectal lesions. Previous studies have demonstrated favorable safety results, however large studies representing a generalizable estimation of adverse events (AEs) are lacking. Our aim was to provide further insight in AEs following eFTR.


      Data from all registered eFTR procedures in the German and Dutch colorectal full-thickness resection device registries between July 2015 and March 2021 were collected. Safety outcomes included immediate and late AEs.


      1892 procedures were included. Overall AE rate was 11.3% (213/1892). No AE-related mortality occurred. Perforations occurred in 2.5% (47/1892), 57.4% immediate (n=27/47) and 42.6% delayed (20/47). Successful endoscopic closure was achieved in 29.8% (13 immediate and 1 delayed) and antibiotic treatment was sufficient in 4.3% (2 delayed). Appendicitis rate for appendiceal lesions was 9.9% (13/131) and 46.2% (n=6/13) could be treated conservatively. Severe AE-rate requiring surgery was 2.2% (42/1892), including delayed perforations in 0.9% (n=17/1892) and immediate perforations in 0.7% (13/1892). Delayed perforations occurred between day 1-10 (median 2) post-eFTR and 58.8% (10/17) was located left-sided. Other severe AEs were appendicitis (0.4%, 7/1892), luminal stenosis (0.1%, 2/1892), delayed bleeding (0.1%, 1/1892), pain following eFTR close to dentate line (0.1%, 1/1892) and grasper entrapment in clip (0.1%, 1/1892).


      Colorectal eFTR is a safe procedure with a low risk for severe AEs in everyday practice and without AE-related mortality. These results further support the position of eFTR as an established minimally invasive technique for complex colorectal lesions.


      AEs (adverse events), ASA (American Society of Anesthesiology score), BMI (body mass index), CRC (colorectal cancer), CI (confidence interval), eFTR (endoscopic full-thickness resection), pEMR ((piecemeal) endoscopic mucosal resection), ESD (endoscopic submucosal dissection), ER (endoscopic resection), FTRD (full-thickness resection device), IQR (interquartile range), ICU (intensive care unit), OR (odds ratio), OTSC (over-the-scope-clip), PPS (post-polypectomy syndrome), SAE (severe adverse event), SD (standard deviation)
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