EFTR using FTRD safe, effective for upper GI lesions

Endoscopic full-thickness resection (EFTR) using a full-thickness resection device (FTRD) results in acceptable complete (R0) resection rates and low recurrence rates with a good safety profile, according to the results of a systematic review and meta-analysis.

“EFTR is a promising technique that allows for a minimally invasive resection of mucosal and submucosal lesions in the gastrointestinal (GI) tract,” the researchers said.

A comprehensive search of several electronic databases and conference proceedings that reported outcomes of EFTR using the FTRD system was performed to assess the efficacy and safety of this technique for upper GI lesions.

Using the random effects model, the research team analysed the weighted pooled rates of technical success, R0 resection, adverse events (AE), and residual or recurrent lesions.

Eight studies including a total of 139 patients who underwent EFTR of upper GI lesions met the eligibility criteria. The pooled weighted rate of technical success was 88.2 percent (95 percent confidence interval [CI], 81.4‒92.7; I², 0), while that of R0 resection was 70.7 percent (95 percent CI, 62.5‒77.8; I², 0). [J Clin Gastroenterol 2024;58:46-52]

Overall rates of AE stood at 22.1 percent (95 percent CI, 15.8‒30.1; I², 0), although the majority of these AEs were mild in nature.

Additionally, the rate of residual or recurrent lesion among patients who had follow-up endoscopy was 6.1 percent (95 percent CI, 2.4‒14.4; I², 0). There was low heterogeneity in the analysis.

“Further prospective studies are required to validate our results and to compare various modalities of endoscopic resection with this single-step EFTR device,” the researchers said.

Technical success

These findings were consistent with those of a recent systematic review and meta-analysis, which found a high technical and clinical success rate, as well as an acceptable safety profile, for EFTR in the management of upper GI lesions. [Surg Endosc 2023;37:3293-3305]

A total of 740 articles were identified in this study, but only six studies, which included 140 patients with 142 lesions, met the eligibility criteria. Four of these studies used the FTRD. The overall technical success rate stood at 86.9 percent (95 percent CI, 79.8‒84; I², 38.9 percent), while the R0 resection rate was 80 percent (95 percent CI, 67.6‒92.3; I², 75.6 percent). [Surg Endosc 2023;37:3293-3305]

AEs had an overall rate of 18.6 percent (95 percent CI, 9.8‒27.2; I², 49.4 percent). Major AEs observed were as follows: major bleeding, micro-perforations, large duodenal perforation, and mucosal damage from FTRD. Notably, only two cases of recurrence occurred at 3‒6 months of follow-up. Both cases failed to achieve R0. [Surg Endosc 2023;37:3293-3305]

In this meta-analysis, the investigators searched the databases of Medline, Embase, Cochrane, Scopus, and ClinicalTrials.gov for studies addressing the outcomes of EFTR for GI lesions through November 2021. They calculated the weighted pooled rates and used Cochran Q test and I statistics to assess heterogeneity.