Endoscopic Transmural Resection of Premalignant and Malignant Colorectal Lesions - Closing the Gap Between Endoscopy and Surgery

Introduction: The evolution of interventional endoscopy and the current techniques and devices for the closure of wall defects with sizes up to 30 mm have enabled the development of minimally invasive endoscopic approaches for the treatment of early malignant and premalignant lesions in the gastrointestinal tract—endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). The application of these current techniques has some limitations in lesions with significant submucosal fibrosis (frequently due to previous endoscopic treatment or taking biopsies) as well as in treating subepithelial lesions. Endoscopic full-thickness resection (EFTR) is a novel revolutionary technique in the management of subepithelial lesions, lesions invading the muscular layer, and lesions with significant submucosal fibrosis or with difficult endoscopic access due to anatomical location. Materials and Methods: We performed a retrospective analysis of a group of 12 patients with complex colorectal lesions unsuitable for standard endoscopic treatment for the period from April 2019 to May 2023. Our primary endpoint was technique efficacy defined as radical excision with clear resection margins. Our secondary endpoint was to evaluate the most common adverse events associated with EFTR.Results: In 100% of the cases, in the following histology report, we found radical excision of the lesion defined as clear margins. As for our secondary endpoint—evaluation of adverse events, we found a rate of 33.3% adverse events (in four of the patients), 3 events of bleeding, and one perforation. All of them were managed endoscopically.Conclusion: The development of interventional endoscopy allows the application of minimally invasive treatment as a definitive treatment of complex colorectal lesions. Full-thickness resection and the option for transmural radical excision could be offered as an alternative to surgical treatment