S2283 Endoscopic Full-Thickness Resection (EFTR) of Gastrointestinal Tract Lesions Is Safe and Effective

Introduction: Endoscopic Full-Thickness Resection (EFTR) is a minimally invasive procedure for resecting gastrointestinal (GI) lesions originating from the muscularis propriae, as distinct from endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) which treat lesions of the mucosa/submucosa only. Current clinical guidelines provide inconsistent recommendations due to the paucity of data. This study aims to retrospectively review clinical data to evaluate the outcomes of EFTR for various gastrointestinal tract lesions. Methods: A retrospective analysis of a prospectively maintained dataset of consecutive patients undergoing EFTR from 07/2022 to 08/2024 in a tertiary medical center by 2 operators. Results: Overall, 40 procedures were performed in 37 patients (Male, 33%; mean age of 57 years). Of these, the location of the lesions were gastric (23/40;58%), colorectal (14/40; 35%); and appendiceal (3/40; 8%). Etiologies included GIST (11/37; 30%), other benign subepithelial lesions (4/37; 11%), benign tissue (11/37; 30%), adenomas (9/37; 24%), and malignant lesions (2/37; 5%). In 29 (72%) of the cases, EFTR was the only resection technique used, whereas in 11/40 (28%) cases, it was used as an adjunct to other resection techniques, such as EMR and/or ESD. The majority of patients (34/37; 92%) achieved an R0 resection. In 2 cases, EFTR was not feasible due to intense fibrosis and lesion size. These were both treated with surgical resection afterwards. There were 2 immediate complications (5%): one perforation and one bleeding, both treated endoscopically. There were 3 (8%) late complications: 2 cases of appendicitis, one of which was managed surgically and the other with medical management, and one melena treated conservatively. All of these occurred within a week of the procedure. During a median follow-up of 12 months, no other complications were noted in the patients who underwent EFTR. Conclusion: EFTR is an effective and safe resection technique for GI lesions, either alone or as an adjunct to other resection techniques. EFTR achieved high rates of R0 resection and was associated with a low rate of complications, most of which were managed non surgically. These findings support the expanding role of EFTR in the minimally invasive management of GI lesions.