ORIGINAL ARTICLE   

Minerva Chirurgica 2020 August;75(4):234-43

DOI: 10.23736/S0026-4733.20.08298-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Comparison among different techniques for en-bloc resection of rectal lesions: transanal endoscopic surgery vs. endoscopic submucosal dissection vs. full-thickness resection device with Over-The-Scope Clip® System

Damiano BISOGNI ¹ ✉, Roberto MANETTI ¹, Luca TALAMUCCI ¹, Francesco CORATTI ², Riccardo NASPETTI ¹, Andrea VALERI ³, Jacopo MARTELLUCCI ³, Fabio CIANCHI ²

¹ Unit of Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy; ² Unit of Gastrointestinal Surgical Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy; ³ Unit of Emergency Surgery, Department of Emergency Medicine, Careggi University Hospital, Florence, Italy

BACKGROUND: The aim of our retrospective study is to compare the efficacy and indications of transanal endoscopic microsurgery (TEM), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection device (FTRD) with Over-The-Scope Clip (OTSC^®) System for en-bloc resection of rectal lesions.
METHODS: This study collected 76 cases of rectal neoplasms from a single hospital institution. Primary endpoints were complete en-bloc resection, intraprocedural adverse events, R0 en-bloc resection and an early discharge of the patient. Secondary endpoints included procedure-related adverse events.
RESULTS: Mean tumor sizes were statistically significant smaller among patients treated with FTRD rather than TEM and ESD. TEO and FTRD treated patients experienced a higher en-bloc resection rate, with a shorter procedure time and hospital stay. No significant difference concerning the R0 resection was found. TEO and FTRD recorded lower perforation rates as compared to ESD, whereas no difference emerged concerning the bleeding rate and the post-polypectomy syndrome rate.
CONCLUSIONS: Our study showed that each technique has specific features, so that each one offers advantages and disadvantages. Nevertheless, all of them ensure high en-bloc resection rates, whereas no difference exists for R0 resection rate. TEO provides the possibility to remove low rectal large lesions as compared to ESD and FTRD.

KEY WORDS: Endoscopic mucosal resection; Transanal endoscopic microsurgery; Colorectal surgery