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A systematic review regarding the feasibility and safety of endoscopic full thickness resection (EFTR) for colonic lesions

机译：关于内镜全层切除术（EFTR）治疗结肠病变的可行性和安全性的系统评价

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Purpose: This review summarizes the published methods of colonic EFTR, examining data on feasibility and safety. Due to the introduction of bowel cancer screening programs, there is an increasing incidence of complex colonic polyps and early colonic cancer that requires segmental colectomy. Traditional radical surgery is associated with significant morbidity, and there is a need for alternative treatments. Methods: Systematic literature search identified articles describing EFTR techniques of colon, published between 1990 and 2012. Complication rates, anastomotic bursting pressures, procedure duration, specimen size and quality, and postmortem findings were analyzed. Results: Five research groups reported four EFTR techniques using endoscopic stapling devices, T-tags, compression closure, or laparoscopic assistance for defect closure before or after specimen resection. A total of 113 procedures were performed in 99 porcine models, with an overall success rate of 89 and 4 % mortality. The intraoperative complication rate was 22 % (0-67 %). Post-resection closure methods more commonly resulted in failure to close the defect (5-55 %) and a high incidence of abnormal findings at postmortem examination (84 %). Significant heterogeneity was observed in procedure duration (median or mean 3-233 min) and size of the excised specimen (median or mean 1.7-3.6 cm). Anastomotic bursting pressures and specimen quality were poorly documented. Conclusions: The technique of EFTR is developing, but the inability to close the resection defect reliably is a major obstacle. The review highlights the challenges that need to be addressed in future preclinical studies.
机译：目的：本综述总结了结肠EFTR的已发表方法，并检查了可行性和安全性数据。由于引入了肠癌筛查程序，复杂的结肠息肉和需要部分结肠切除术的早期结肠癌的发病率增加。传统的根治性手术与高发病率相关，因此需要替代疗法。方法：系统性文献检索鉴定了1990年至2012年发表的描述结肠EFTR技术的文章。分析了并发症发生率，吻合口破裂压力，手术时间，标本大小和质量以及死后的发现。结果：五个研究小组报告了四种EFTR技术，这些技术在标本切除之前或之后使用内窥镜缝合器械，T标签，压缩闭合或腹腔镜辅助进行缺陷闭合。在99个猪模型中总共进行了113次手术，总成功率为89％，死亡率为4％。术中并发症发生率为22％（0-67％）。切除后闭合方法通常导致闭合缺陷失败（5-55％）和死后检查中异常发现的高发生率（84％）。在手术持续时间（中值或中值3-233分钟）和切除标本的大小（中值或中值1.7-3.6 cm）中观察到明显的异质性。吻合破裂压力和样品质量的文献资料很少。结论：EFTR技术正在发展，但不能可靠地闭合切除缺损是主要障碍。审查强调了未来临床前研究中需要解决的挑战。

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