Sa2024 ENDOSCOPIC FULL THICKNESS RESECTION OF GASTRIC AND DUODENAL LESIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Endoscopic full thickness resection (EFTR) is a novel endoscopic technique for the resection of lesions in the gastrointestinal tract that are otherwise not amenable to standard endoscopic resection, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Several studies have evaluated its efficacy and safety in the resection of lesions located in the stomach and duodenum with varying results of technical success and resection rates. The primary aim of this study was to perform a structured systematic review and meta-analysis to evaluate EFTR for the resection of gastric and duodenal lesions. Individualized search strategies were developed for PubMed, EMBASE, Web of Science, and Cochrane Library databases from inception through October 2019 in accordance with PRISMA and MOOSE guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Studies with ≤3 patients were excluded to minimize selection bias. Measured outcomes included technical success, margin-negative (R0) resection rates, adverse events, procedure duration, and rate of recurrence at follow-up. Sensitivity analyses were performed for only full-text manuscript outcomes. Heterogeneity was assessed with I2 statistics and publication bias by funnel plot using Egger and Begg tests. A total of 13 studies (n=656 patients; 58.55% female) were included in this meta-analysis. Three studies were prospective with the remaining studies retrospective in nature. Five abstracts were included. Mean age of patients was 57.24 ±4.85 years with an average lesion size of 17.93 ±4.70 mm. Duodenal lesions accounted for 11.84% of included lesions that underwent EFTR with the remaining lesions located in the stomach. Subepithelial lesions accounted for 71.6% of lesions encountered. Cap assisted FTR was used in 61% of cases. Mean procedure duration for EFTR was 63.67 ±14.39 min. Pooled technical success was 95.07% (95% CI, 90.86 to 97.40) with a R0 resection rate of 88.45% (95% CI, 75.57 to 94.99). Total procedure-associated adverse events occurred in 25.11% (95% CI 14.80 to 39.30) of patients though a majority were mild with a serious adverse event rate of 4.15% (95% CI, 1.86 to 9.03). Among serious adverse events, 48.94% were related to bleeding or perforation. The rate of recurrence post-EFTR was 2.98% (95% CI, 1.42 to 6.15%) at a mean follow-up of 30.96 ±25.52 months. Endoscopic full thickness resection has revolutionized the approach to lesions not amenable to EMR or ESD. Based upon the results of this meta-analysis, EFTR of gastric and duodenal lesions appears to be an effective modality with high technical success and R0 resection rate with low risk of serious adverse events and recurrence.