LAUSR

BACKGROUND AND AIMS Endoscopic full-thickness resection (EFTR) is a novel endoscopic technique for the resection of gastrointestinal lesions not amenable to standard endoscopic therapy. The primary aim of this study is to perform a systematic review and meta-analysis to evaluate EFTR for the resection of colorectal lesions. METHODS Individualized searches were developed through October 2020 in accordance with PRISMA and MOOSE guidelines. Random effects models were used to determine pooled technical success, margin negative (R0) resection, adverse events, procedure duration, and rate of recurrence at follow-up. Subgroup analysis was used to assess impact of specific procedure technique and regression analyses to determine influence of lesion size. Heterogeneity was assessed with I2 statistics and publication bias by funnel plot using Egger and Begg tests. RESULTS Fourteen studies (n=1936; 39.6% female) were included. Most EFTR lesions were located in the colon (75.8%) with remaining in the rectum. Mean procedure duration was 45.4±11.4 minutes. Pooled technical success was 87.6% (95% CI, 85.1-89.8; I2=33), R0 resection rate was 78.8% (95% CI, 75.7-81.5; I2=33), procedure-associated adverse events occurred in 12.2% (95% CI, 9.3-15.9; I2=61) and recurrence rate was 12.6% (95% CI, 11.1-14.4; I2=0) over an average weighted follow-up of 20.1±3.8 weeks. Regression analyses revealed significantly lower R0 resection (OR, 0.3; 95% CI, 0.2-0.6; I2=61; p=0.0003) and higher overall procedure-associated adverse event rates (OR, 3.5; 95% CI, 1.8-7.2; I2=55; p=0.0004) for lesions >20 mm. CONCLUSIONS EFTR overall appears to be an effective modality with high technical success and R0 resection rate with relatively low risk of adverse events and recurrence, with greatest success when lesions are <20 mm.