B0453 - Endoscopic Full Thickness Resection of Gastrointestinal Neoplasia – Single Center Experience

Sebastian Stefanovic, MD, Maja Denkovski, MD, Zoran Stanisic, MD, Natasa Brglez Jurecic, MD, Ljiljana Ljepovic, MD, Marjan Gorjenc, MD, Andreja Hvalic Klanjscek, MD, Davorin Dajcman, MD, Dejan Urlep, MD, Rajko Knezevic, MD, Milan Stefanovic, MD
Diagnostic Center Bled, Bled, Bled, Slovenia

Introduction: Endoscopic full-thickness resection (EFTR) is emerging therapeutic option for en-bloc treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. Study aim was to evaluate results at advanced endoscopy center.

Methods: This was retrospective analysis of 18 EFTR cases from 01/2020 till 11/2021, that were performed in advanced endoscopy center with a dedicated full thickness resection device (FTRD®, Ovesco, Germany). We recorded the demographic, procedural and technical characteristics. Lesion pathology (surface size, type, location), timing of procedure, technical success (defined as reaching the lesion, deploying the clip, and performing an en bloc and macroscopically complete resection), clinical success (defined as R0 resection and histopathology evaluation compatible with adequate endoscopic treatment) and rate of procedure-related complications (bleeding, perforation, need for emergency surgery, infectious complications and cardio-pulmonary adverse events associated with sedation) were also recorded (Table 1).

Results: Majority of lesions had previous failed attempts at removal (n=10, 55.5%). Other lesions (n=8, 44.4%) included appendiceal orifice (n=6, 33.3%) or neuroendocrine neoplasia (n=2, 11.1%).




Mean age of patients was 67.4 years +/- (SD) 10.9 years. 8/18 (44.4%) patients were female. Procedures were performed with conscious sedation (midazolam) and analgesia (piritramide), with pulse oximetry monitoring. There were no cardiopulmonary adverse events.




One procedure was aborted due to postsurgical anatomy; the endoscope with the FTRD device could not be passed through. One patient developed post procedural appendicitis and a surgical appendectomy was performed, although the EFTR was technically successful. No other complications were recorded. Mean procedure time was 42.1 +/- (SD) 14.3 minutes. Technical success of the procedure was 94.4% (n=17/18), clinical success was achieved in 88.2% (n=15/17). One patient was referred to surgery due to insufficient safety margins of removed specimen and one patient due to presence of invasive adenocarcinoma (pT2). All but one (post-procedural appendicitis) patients were discharged after one day of observation.

Discussion: Our results confirm that EFTR is effective endoscopic technique. It is exceptionally useful in fibrotic lesions and neuroendocrine neoplasia. Technically less challenging than endoscopic submucosal dissection it can still pose technical difficulties especially in cases with postsurgical anatomy.




Disclosures:


Sebastian Stefanovic, MD, Maja Denkovski, MD, Zoran Stanisic, MD, Natasa Brglez Jurecic, MD, Ljiljana Ljepovic, MD, Marjan Gorjenc, MD, Andreja Hvalic Klanjscek, MD, Davorin Dajcman, MD, Dejan Urlep, MD, Rajko Knezevic, MD, Milan Stefanovic, MD. B0453 - Endoscopic Full Thickness Resection of Gastrointestinal Neoplasia – Single Center Experience, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.