Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis

Background and Aims: Endoscopic full-thickness resection (EFTR) is a novel endoscopic technique for the resection of GI lesions not amenable to standard endoscopic therapy. The primary aim of this study was to perform a systematic review and meta-analysis to evaluate EFTR for the resection of colorectal lesions. Methods: Individualized searches were developed through October 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Random-effects models were used to determine pooled technical success, margin-negative (R-0) resection, adverse events, procedure duration, and rate of recurrence at follow-up. Subgroup analysis was used to assess the impact of specific procedure techniques and regression analyses to determine influence of lesion size. Heterogeneity was assessed with I-2 statistics and publication bias by funnel plots using Egger and Begg tests. Results: Fourteen studies (1936 subjects; 39.6% women) were included. Most EFTR lesions were located in the colon (75.8%) with the remaining in the rectum. Mean procedure duration was 45.4 +/- 11.4 minutes. Pooled technical success was 87.6% (95% confidence interval [CI], 85.1-89.8; I-2 = 33), R-0 resection rate was 78.8% (95% CI, 75.7-81.5; I-2 = 33), procedure-associated adverse events occurred in 12.2% (95% CI, 9.3-15.9; I-2 = 61), and recurrence rate was 12.6% (95% CI, 11.1-14.4; I-2 = 0) over an average weighted follow-up of 20.1 +/- 3.8 weeks. Regression analyses revealed significantly lower R-0 resection (odds ratio, .3; 95% CI, .2-.6; I-2 = 61; P = .0003) and higher overall procedure-associated adverse event rates (odds ratio, 3.5; 95% CI, 1.8-7.2; I-2 = 55; P = .0004) for lesions >20 mm. Conclusions: EFTR overall appears to be an effective modality with high technical success and R-0 resection rate with a relatively low risk of adverse events and recurrence, with greatest success when lesions are <20 mm.