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Related Experiment Video

Updated: Jun 26, 2025

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Published on: March 24, 2023

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

Giulia Gibiino¹, Cecilia Binda¹, Luigi Giovanni Papparella²

¹Gastroenterology and Digestive Endoscopy Units, Morgagni - Pierantoni Hospital, Forlì, and Maurizio Bufalini Hosptial, Cesena, Italy.

|May 16, 2024

Summary

Endoscopic full-thickness resection (EFTR) using the FTRD system for colorectal lesions has a notable rate of technical failure, primarily due to snare or clip issues. Rescue endoscopic mucosal resection is often successful, but requires experienced multidisciplinary teams.

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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.