F. Di Matteo

Colo-rectal endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD®): A multicenter Italian experience

BACKGROUND AND AIM Endoscopic full-thickness resection(EFTR) with FTRD® in colo-rectum may be useful for several indications.The aim was to assess its efficacy and safety. MATERIAL AND METHODS In this retrospective multicenter study 114 patients were screened; 110 (61M/49F, mean age 68 ± 11 years, range 20-90) underwent EFTR using FTRD®. Indications were:residual/recurrent adenoma (39), incomplete resection at histology (R1 resection) (26), non-lifting lesion (12), adenoma involving the appendix (2) or diverticulum (2), subepithelial lesions(10), suspected T1 carcinoma (16), diagnostic resection (3). Technical success (TS: lesion reached and resected), R0 resection (negative lateral and deep margins),EFTR rate(all layers documented in the specimen) and safety have been evaluated. RESULTS TS was achieved in 94.4% of cases. EFTR was achieved in 91% with lateral and deep R0 resection in 90% and 92%. Mean size of specimens was 20 mm (range 6-42). In residual/recurrent adenomas, final analysis revealed: low-risk T1 (11), adenoma with low-grade dysplasia (LGD) (24) and high-grade dysplasia (HGD) (3), scar tissue (1). Histology reports of R1 resections were: adenoma with LGD (6), with HGD (1), low-risk (6) and high-risk (1) T1, scar tissue (12). Non-lifting lesions were diagnosed as: adenoma with HGD (3), low-risk (7) and high risk (2) T1. Adverse clinical events occurred in 12 patients (11%),while adverse technical events in11%. Three-months follow-up was available in 100 cases and residual disease was evident in only seven patients. CONCLUSIONS EFTR using FTRD® seems to be a feasible, effective and safe technique for treating selected colo-rectal lesions. Comparative prospective studies are needed to confirm these promising results.

P.03.9 FEASIBILITY OF EUS-GUIDE ND: YAG LASER ABLATION OF THE HEPATOCELLULAR CARCINOMA

Background and aim: We previously described a case of EUS-guided Nd:YAG (neodymium:yttrium-aluminium-garnet) LA of a HCC lesion located into the caudate lobe, not suitable for percutaneous approach. Aim is to confirm the feasibility of EUS-guided Nd:YAG LA of HCC in unsafe conditions for the percutaneous approach. Material and methods: Treatment was performed in 2 patients with multifocal HCC unsuitable for surgical resection or liver transplant. First one was affected by criptogenetic liver cirrhosis Child-Pugh A6 and lesion was site in the caudate lobe with huge ombelical vein and portal hypertension. The location of the lesion and the difficult ultrasonography visualization precluded percutaneous treatment. Second patient was affected by HCV and HIV cirrhosis Child-Pugh B9 with ascites and portal hypertension. Both patients underwent previous failed transarterial embolization (TACE) and RFA of lesions located into segment 1 and 3 respectively. Trans-gastric EUS-puncture was performed using a 22-gauge needle following the application of Doppler. A Nd:YAG laser with a wavelength of 1.064 nm was used. As previously described the treatment was planned taking into account the baseline volume of the lesions at EUS and the volume of necrosis that could be achieved in relation to the energy delivered. Results: Lesions were easier targeting through the lesser gastric curve. Application of Nd:YAG LA did not have any negative effect on the quality of the EUS images during the treatment and the whole treated area was occupied by an irregular and poorly defined echogenic zone at the end. The patients didn’t report any pain or abdominal discomfort after treatment and were discharged on the third postoperative day without complications. CT performed 24 hours after procedure showed the whole treated area replaced by an homogeneous, hypoattenuating, nonenhancing area. At 2 months follow-up clinical examination and blood analysis tests were normal. CT-scan showed uniform hypoattenuation without enhancement in the ablated zone and confirm the success to ablate the entire lesion. Conclusions: EUS-guided Nd:YAG LA of a HCC is feasible and safe in lesions in which the percutaneous approach is unsure. This promising results need to be confirmed in additional patients with lesions difficult to reach by conventional ablative methods or in patients whit compromised clinical conditions.