Introduction:
Improvements in endoscopic techniques and the advent of full-thickness resection devices have enabled the management of larger colonic lesions that traditionally require surgical intervention. Despite these advances, the complete resection of certain complex lesions remains difficult. Hybrid eFTR is a novel technique that combines endoscopic mucosal resection with full-thickness resection by using an FTR device. We conducted a systematic review and meta-analysis of the effectiveness and safety profiles of hybrid eFTR.

Methods:
We searched multiple databases from inception to August 2023 to identify studies that reported the effectiveness and safety of hybrid eFTR. The outcomes of technical success, clinical success, and adverse events were evaluated. Pooled proportions were calculated using both fixed and random effects models.

Results:
Five studies with 139 patients were included in the final analysis. The weighted mean lesion size was 30.54 mm (SD = 10.75), with most of the lesions removed in the ascending colon (n = 34). The weighted mean procedure time was 78.95 min (SD = 8.54). The pooled rate of technical success for Hybrid eFTR was 97.14% (95% CI, 93.75 - 99.24). The pooled rate of clinical success for the hybrid eFTR was 95.42% (95% CI, 91.38 – 98.23). Overall, the pooled rate of R0 resection (complete resection) was 83.87% (95% CI, 74.06 – 91.65). Superficial malignancy was found in twenty-one of all the resected lesions, ten of these patients underwent oncologic resection given presence of high risk features on histology. The pooled rates of residual or recurrent lesions after resection were 7.73% (95% CI, 3.92 – 12.69). The Pooled rate of post-polypectomy syndrome was 1.37% (95% CI, 0.12 – 3.95). The pooled rate of post-procedural bleeding was 3.59% (95% CI, 1.17 – 7.28), and the pooled rate of post-procedural perforation was 1.28% (95% CI, 0.09 – 3.79). The pooled rate of procedure-associated appendicitis was 2.28% (95% CI, 0.47 – 5.37).

Conclusions:
The hybrid eFTR technique has high technical and clinical success rates with complete resection of the lesion. The procedure is also associated with low rates of residual or recurrent lesions and adverse events.

Figure: Pooled rate of technical success for Hybrid eFTR.

Muhammad Asghar

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