Post written by Russell D. Dolan, MD, from the Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA.

As techniques have advanced to improve endoscopic removal of large lesions within the colon and rectum to serve as alternatives to surgery, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have evolved as effective methods.

However, they are limited by a comparatively high lesion recurrence rate (EMR) or requirement for extensive training (ESD). Furthermore, lesion proximity to colorectal structures such as the appendix or a diverticulum can further limit resection using these strategies.

Endoscopic full-thickness resection (EFTR) has been studied as an alternative technique not limited by the lesion depth and potentially not requiring extensive training to develop proficiency. Studies have evaluated EFTR with varying results.

Our systemic review and meta-analysis study was pursued to evaluate the efficacy and safety of EFTR in the resection of colon and rectum lesions, with a focus on over-the-scope methods. The study provides a large-scale evaluation of EFTR to determine technical success, margin negative (R₀) resection rate, adverse event rate, and lesion recurrence rate in resection of colon and rectum lesions.

This study demonstrated that colorectal EFTR is associated with a high rate of technical success. However, it is limited, with a modest margin negative (R₀) resection rate and a relatively high rate of adverse events. This is particularly true when attempting resection of larger lesions (>20 mm), likely due to the full-thickness resection device (over-the-scope-clip assembly) containing a 21-mm diameter.

Subsequently, further study evaluating the open EFTR approach using an ESD knife and suturing should be evaluated to determine utility in resection of larger lesions.

Despite an overall high heterogeneity among included studies, this was reduced among prospective studies (n = 4), and further prospective evaluation using EFTR can further help delineate appropriate patient selection, particularly when compared to EMR and ESD.

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