Real-world topographical efficacy, procedural outcome and safety of endoscopic full thickness resection in colon segments

doi:10.4253/wjge.v17.i10.112380

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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World J Gastrointest Endosc. Oct 16, 2025; 17(10): 112380
Published online Oct 16, 2025. doi: 10.4253/wjge.v17.i10.112380

Real-world topographical efficacy, procedural outcome and safety of endoscopic full thickness resection in colon segments

Heinz Albrecht, Claus Schaefer, Andreas Stegmaier, Juergen Gschossmann, Alexander Hagel, Martin Raithel

Heinz Albrecht, Alexander Hagel, Department of Medicine I, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen 91054, Bavaria, Germany

Claus Schaefer, Department of Internal Medicine II, Klinikum Neumarkt i. d. Oberpfalz, Neumarkt 92318, Bavaria, Germany

Andreas Stegmaier, Department of Internal Medicine II, Krankenhaus Martha-Maria St. Theresien, Nuremberg 90491, Bavaria, Germany

Juergen Gschossmann, Department of Internal Medicine, Klinikum Forchheim, Forchheim 91301, Bavaria, Germany

Martin Raithel, Department of Medicine II, Gastroenterology and Interventional Endoscopy, Malteser Waldkrankenhaus St. Marien Erlangen, Erlangen 91054, Bavaria, Germany

Author contributions: Albrecht H and Raithel M were responsible for conception or design of the work, acquisition, analysis and interpretation of data for the work, drafting the work; Schäfer C, Stegmaier A, Gschossmann J and Hagel A were responsible for acquisition, analysis and interpretation of data for the work, reviewing it critically for important intellectual content and final approval of the version to be published.

Institutional review board statement: This retrospective study was conducted in accordance with all relevant guidelines and regulations applicable in Germany. According to local regulations, neither ethics committee approval nor registration was required due to the non-interventional retrospective design and therefore no approval number was assigned. The study was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.

Informed consent statement: Due to the retrospective nature of the study no extra approval or written informed consent was required.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Data sharing statement: All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Corresponding author: Heinz Albrecht, Department of Medicine I, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, Erlangen 91054, Bavaria, Germany. heinz.albrecht@fau.de

Received: July 25, 2025
Revised: August 5, 2025
Accepted: August 25, 2025
Published online: October 16, 2025
Processing time: 83 Days and 12.2 Hours

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.

Keywords: Endoscopic full thickness resection; Full thickness resection device; Colorectal neoplasms; Colorectal topography; Endoscopy; Endoscopic mucosal resection

Core Tip: Endoscopic full thickness resection (EFTR) using full-thickness resection device achieved an overall histologically complete resection (R0) rate of 81.4% with a high technical success rate (99.0%), confirming its applicability in routine clinical settings. R0 resection rates and adverse event (AE) frequencies varied by colonic segment, with the rectum showing the numerically highest efficacy and lowest complication rate, while the transverse colon had the numerically lowest R0 rate and highest AE rate. Postsurgical abdominal pain occurred significantly less often in rectal compared to transverse colon EFTR. These findings suggest that lesion topography plays a relevant role in EFTR outcomes and should be considered in patient counseling, clinical decision-making, and endoscopic training.