Device assisted endoscopic full thickness resection in colorectum: A systematic review and meta-analysis

Background and aim: Endoscopic full thickness resection (EFTR) is emerging as an effective modality for mucosal and submucosal lesions in colorectum. In this systematic review and meta-analysis, we aimed to analyze the success and safety of device assisted EFTR in colon and rectum. Methods: A literature search was performed in Embase, PubMed, Medline databases for studies evaluating device assisted EFTR between inception to October-2022. The primary outcome of the study was clinical success (R0 resection) with EFTR. Secondary outcomes included technical success, procedure duration and adverse events. Results: 29 studies with 3467 patients [59% males, 3492 lesions] were included in the analysis. The lesions were located in right colon (47.5%), left colon (28.6%) and rectum (24.3%). EFTR was performed for sub-epithelial lesions in 7.2% patients. Pooled mean size of the lesions was 16.6 mm (95% CI 14.9 - 18.2, I 2 98%). Technical success was achieved in 87.1% (95% CI 85.1%-88.9%, I2 39%) procedures. The pooled rate of en bloc resection was 87.9% (95% CI 85.1%-88.9%, I2 50%) and R0 resection was 81.6% (95% CI 78.8% to 84.2%, I2 57%). In sub-epithelial lesions, pooled rate of R0 resection was 94.3% (95% CI 89.7% to 96.9%, I2 0%). Pooled rate of adverse events was 12.1%(95% CI 10.3%-14.1%, I2 44%) and major adverse events requiring surgery was 2.5% (95% CI 2.0%-3.1%, I2 0%). Conclusion: Device assisted EFTR is a safe and effective treatment modality in cases with adenomatous and sub-epithelial colorectal lesions. Comparative studies are required with conventional resection techniques including endoscopic mucosal resection and submucosal dissection.