Systematic review and meta-analysis on effectiveness and safety of the full-thickness resection device (FTRD) in the colon

Background Endoscopic full-thickness resection (EFTR) has expanded the possibilities of endoscopic resection. The fullthickness resection device (FTRD, Ovesco Endoscopy, Tubingen, Germany) combines a clip-based defect closure and snare resection in a single device. Methods Systematic review and meta- analysis on effectiveness and safety of the FTRD in the colon. Results A total of 26 studies (12 published as full-text articles and 14 conference papers) with 1538 FTRD procedures were included. The pooled estimate for reaching the target lesion was 96.1 % (95 % confidence interval [95 % CI]: 94.6- 97.1) and 90.0 % (95 % CI: 87.0-92.3) for technically successful resection. Pooled estimate of histologically complete resection was 77.8% (95% CI: 74.7-80.6). Adverse events occurred at a pooled estimate rate of 8.0 % (95 % CI: 5.8-10.4). Pooled estimates for bleeding and perforation were 1.5 % (95 % CI: 0.3-3.3) and 0.3 % (95 % CI: 0.0- 0.9), respectively. The rate for need of emergency surgery after FTRD was 1.0 % (95 % CI: 0.4-1.8). Conclusion The use of the FTRD in the colon shows very high rates of technical success and complete resection (R0) as well as a low risk of adverse events. Emergency surgery after colonic FTRD resection is necessary in single cases only.