Abstract
BACKGROUND: Despite growing evidence on endoscopic full thickness resection (EFTR), data on segment-specific outcomes in real-world patients remain limited. AIM: To investigate segment-specific outcomes of EFTR using a full-thickness resection device (FTRD) for neoplastic colorectal lesions. METHODS: In this multicenter, retrospective study, EFTR was conducted in unselected real-world patients referred to participating German centers after colonoscopy confirmed EFTR eligibility. The primary outcome was histologically complete resection (R0) of the lesion, including segment-specific outcomes and adverse events (AE). Additional efficacy and safety parameters were investigated by colonic topography for up to 30 days. RESULTS: The analysis included 102 patients (64 males, 38 females) with a median age of 70 years. EFTR via FTRD was technically successful in all patients. The R0 rate was 81.4%, segment-specifically ranging from 85.0% (rectum), 84.6% (descending colon), 84.0% (ascending colon), 83.3% (cecum), and 76.5% (sigmoid colon) to 73.3% (transverse colon). Examination time was longer in proximal parts compared to the rectosigmoid (non-significant). Overall, 33 patients (32.4%) experienced AE, including only one major complication (0.98%; perforation of sigmoid colon). Abdominal postsurgical pain (18.6%), hematochezia (9.8%), and hemoglobin decline (7.8%) were the most frequent minor complications. Transverse colon lesions had the numerically highest rate of AE, with 8 of 15 patients (53.3%) affected. CONCLUSION: EFTR is efficacious for neoplastic colorectal lesions, though R0 rates vary by location. This may impact patient education, selection of the operator, and consideration of laparoscopy surgery.