Technical failure during colorectal endoscopic full-thickness resection: the "through thick and thin" study.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Surgery

Background:

• Endoscopic full-thickness resection (EFTR) is a recognized technique for managing nonlifting colorectal lesions.
• While effective, technical challenges and failures with the full-thickness resection device (FTRD) system have been reported.
• Detailed data quantifying and classifying these FTRD technical failures are limited.

Purpose of the Study:

• To quantify the rate of technical failures associated with the FTRD system during colorectal EFTR.
• To classify the types of technical failures encountered.
• To evaluate the subsequent management, clinical success, and complication rates following FTRD failures.

Main Methods:

• A retrospective study was conducted across 17 Italian centers experienced in advanced endoscopic resection.
• Data from prospectively collected consecutive colorectal EFTR procedures using the FTRD between 2018 and 2022 were analyzed.
• Technical failure rates, classifications, subsequent treatments, and outcomes were the primary and secondary endpoints.

Main Results:

• Out of 750 EFTR procedures, technical failures occurred in 77 patients (10.3%).
• Failures were classified as Type I (snare noncutting, 53%), Type II (clip misdeployment, 31%), and Type III (cap misplacement, 16%).
• Rescue endoscopic mucosal resection was performed in 74% of cases, achieving en bloc and R0 resection in 71% and 64%, respectively. The overall adverse event rate was 27.3%.

Conclusions:

• Colorectal EFTR using the FTRD system presents a significant rate of technical failure and associated complications.
• Effective management necessitates expertise in rescue resection techniques and a multidisciplinary approach.
• Failure rates and outcomes were comparable between high- and low-volume centers.