Efficacy and safety of combined EMR and endoscopic full-thickness resection (hybrid EFTR) for large nonlifting colorectal adenomas

Background and Aims Endoscopic full-thickness resection (EFTR) with the full-thickness resection device (FTRD) has become the standard technique for selected non-lifting colorectal adenoma but tumor size is the major limitation. However, large lesions might be approached in combination with endoscopic mucosal resection (EMR). Herein, we report the largest single-center experience to date of combined EMR/EFTR (Hybrid-EFTR) in patients with large (≥ 25 mm) non-lifting colorectal adenoma not amenable to EMR or EFTR alone. Methods This is a single-center retrospective analysis of consecutive patients who underwent Hybrid-EFTR of large (≥ 25 mm) non-lifting colorectal adenoma. Outcomes of technical success (successful advancement of the FTRD with consecutive successful clip deployment and snare resection), macroscopic complete resection, adverse events and endoscopic follow-up were evaluated. Results 75 patients with non-lifting colorectal adenoma were included. Mean lesion size was 36.5 mm (range 25-60 mm) and 66.6 % were located in the right-sided colon. Technical success was 100 % with macroscopic complete resection in 97.3 %. Mean procedure time was 83.6 minutes. Adverse events occurred in 6.7 % leading to surgical therapy in 1.3 %. Histology revealed T1 carcinoma in 16 %. Endoscopic follow-up was available in 93.3 % (mean follow-up time: 8.1 months, range 3-36 months) and showed no signs of residual or recurrent adenoma in 88.6 %. Recurrency (11.4 %) was treated endoscopically. Conclusions Hybrid-EFTR is safe and effective for advanced colorectal adenoma which cannot be approached by EMR or EFTR alone. Hybrid-EFTR expands the indication of EFTR substantially in selected patients.