Endoscopic full-thickness resection of colonic lesions

The introduction of colon cancer screening programs has led to detection of an increasing incidence of complex colonic polyps and early colon cancer requiring colectomy. Traditional radical colonic resection risks substantial morbidity and there is a need for alternative approaches. This review summarizes the published methods of colonic endoscopic full-thickness resection (EFTR), examining data on feasibility and safety. Preclinical research reported on 3 EFTR techniques using endoscopic stapling devices, T-tags, or compression device closure for defect closure before or after specimen resection. A total of 103 procedures were performed in 99 porcine models, with an overall success rate of 87% (90 of 103 procedures). The intraoperative complication rate was 19% (19 of 90 procedures). When bowel closure was performed after resection, rather than before it, there were higher rates of failure to close the defect and a high incidence of abnormal findings at postmortem examination. Clinical experience involved 5 studies reporting EFTR in 38 patients; of these, 3 used compression device preresection closure and 1 used postresection closure. EFTR was completed in 33 individuals without assistance. Only 3 patients had complications. Lateral margin clearance was variably reported and complete full-thickness resection was achieved in only 12 of 17 patients. The technique of EFTR is evolving, with only limited clinical evidence to date, but currently preresection closure methods seem advisable. Significant technological challenges remain, including reproducible lateral margin clearance before colonic EFTR can be recommended.