Device-assisted endoscopic full-thickness resection in colorectum: Systematic review and meta-analysis

Endoscopic full-thickness resection (EFTR) is emerging as an effective modality for mucosal and submucosal lesions in the colorectum. In this systematic review and meta-analysis, we aimed to analyze the success and safety of device-assisted EFTR in the colon and rectum.

A literature search was performed in the Embase, PubMed, and Medline databases for studies evaluating device-assisted EFTR between inception to October 2022. The primary outcome of the study was clinical success (R0 resection) with EFTR. Secondary outcomes included technical success, procedure duration, and adverse events.

In all, 29 studies with 3467 patients (59% male patients, 3492 lesions) were included in the analysis. The lesions were located in right colon (47.5%), left colon (28.6%), and rectum (24.3%). EFTR was performed for subepithelial lesions in 7.2% patients. The pooled mean size of the lesions was 16.6 mm (95% confidence interval [CI] 14.9-18.2, I² 98%). Technical success was achieved in 87.1% (95% CI 85.1-88.9%, I² 39%) procedures. The pooled rate of en bloc resection was 88.1% (95% CI 86-90%, I² 47%) and R0 resection was 81.8% (95% CI 79-84.3%, I² 56%). In subepithelial lesions, the pooled rate of R0 resection was 94.3% (95% CI 89.7-96.9%, I² 0%). The pooled rate of adverse events was 11.9% (95% CI 10.2-13.9%, I² 43%) and major adverse events requiring surgery was 2.5% (95% CI 2.0-3.1%, I² 0%).

Device-assisted EFTR is a safe and effective treatment modality in cases with adenomatous and subepithelial colorectal lesions. Comparative studies are required with conventional resection techniques, including endoscopic mucosal resection and submucosal dissection.