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• W4246870483 abstract "We read with great interest the comment by Dr Li and colleagues1Li P. Ma B. Li W. What is the true effect of endoscopic full-thickness resection on early colorectal cancer?.Gastrointest Endosc. 2019; 90: 539-540Abstract Full Text Full Text PDF Scopus (1) Google Scholar referring to our study on endoscopic full-thickness resection (EFTR) for early colorectal cancer.2Kuellmer A. Mueller J. Caca K. et al.Endoscopic full-thickness resection for early colorectal cancer.Gastrointest Endosc. 2019; 89: 1180-1189Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar We would like to thank the editors for the opportunity to reply. It is true that a significant proportion of lesions (32.1%) in our study were located in the rectum. Endoscopic submucosal dissection (ESD) is a feasible and effective treatment option in the rectum with higher success and lower perforation rates than in the colon. However, available studies have investigated lesions that can be effectively lifted by submucosal injection. Studies on nonlifting lesions, carcinomas, or both are scarce. Our study included postpolypectomy scars (group 1) and treatment-naïve carcinomas. In both cases, insufficient lifting due to scarring, submucosal tumor infiltration, or both can be expected. ESD is associated with an increased risk of perforation in the presence of submucosal scarring.3Mizushima T. Kato M. Iwanaga I. et al.Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors.Surg Endosc. 2015; 29: 133-139Crossref PubMed Scopus (76) Google Scholar Moreover, the technique is time consuming and technically difficult. EMR, by contrast, is challenging for nonlifting lesions. EFTR with the full-thickness resection device (FTRD) system has been shown to be feasible for nonlifting lesions of various causes.4Schmidt A. Beyna T. Schumacher B. et al.Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications.Gut. 2018; 67: 1280-1289Crossref PubMed Scopus (153) Google Scholar The technique may require less training than ESD with short procedure times. The mean procedure time for all lesions in our study was 35 minutes, which is almost half of the median times reported by Repici and colleagues5Repici A. Hassan C. De Paula Pessoa D. et al.Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review.Endoscopy. 2012; 44: 137-150Crossref PubMed Scopus (207) Google Scholar for similar lesions. With this method, the endoscopist is able to deliver a full-thickness specimen to the pathologist, which may allow more exact histologic risk stratification, especially in terms of submucosal infiltration depth. We therefore do not agree that this approach is “too radical” for malignant lesions. In our study, exact histologic risk stratification was possible in 99.3% of patients, which reflects the excellent diagnostic yield of EFTR. A key unresolved issue is whether R0 ESD or EFTR of lesions with features associated with lymphatic or distant metastases should be considered curative or should require adjuvant therapies. Concerning the influence of lesion size (and other lesion characteristics) on R0 resection, we agree that our results are not in line with those of other studies4Schmidt A. Beyna T. Schumacher B. et al.Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications.Gut. 2018; 67: 1280-1289Crossref PubMed Scopus (153) Google Scholar and also do not reflect personal experience. However, most of our study data are derived from a registry that contains very limited information about lesion characteristics. Moreover, lesion size was not measured in a standardized way but rather was estimated by the endoscopist. This is a limitation of our analysis that was discussed in the article.2Kuellmer A. Mueller J. Caca K. et al.Endoscopic full-thickness resection for early colorectal cancer.Gastrointest Endosc. 2019; 89: 1180-1189Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar We agree that further studies may need to address this question. Dr Schmidt is the recipient of lecture fees from Ovesco Endoscopy. The other authors disclosed no financial relationships relevant to this publication. What is the true effect of endoscopic full-thickness resection on early colorectal cancer?Gastrointestinal EndoscopyVol. 90Issue 3PreviewWe read with interest the article by Kuellmer et al1 evaluating endoscopic full-thickness resection (EFTR) for early colorectal cancer. The authors found that EFTR for early colorectal cancer was feasible and safe. Because their findings are important to current practice, several questions deserve attention. Full-Text PDF" @default.
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• W4246870483 doi "https://doi.org/10.1016/j.gie.2019.05.022" @default.
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