内窥镜全层切除术（EFTR）结合全层切除装置（FTRD）已成为选定的非隆起性结直肠腺瘤的标准技术，但是肿瘤大小是主要的限制因素。然而，大的病变可以与内窥镜粘膜切除（EMR）结合治疗。在这里，我们报告迄今为止针对大的（≥25毫米）非隆起性结直肠腺瘤患者进行结合EMR/EFTR（混合-EFTR）的最大单中心经验。这是一项连续患者单中心回顾性分析，受试者接受了大的（≥25毫米）非隆起性结直肠腺瘤的混合-EFTR。评估技术成功率（成功推进FTRD，连续成功夹子固定和剪切切除）、宏观完整切除、不良事件和内窥镜随访等结果。共纳入75例非隆起性结直肠腺瘤患者，平均病损大小为36.5毫米（范围为25-60毫米），其中66.6%位于右侧结肠。技术成功率为100％，宏观完整切除率为97.3％。平均操作时间为83.6分钟。6.7％的患者发生不良事件，其中1.3％需要外科治疗。组织学检查发现16％为T1癌。内窥镜随访可供93.3％的患者使用（平均随访时间：8.1个月，范围为3-36个月），88.6％的患者未出现残留或复发的腺瘤。复发率为11.4％，经内窥镜治疗。混合-EFTR对于EMR或EFTR无法单独治疗的先进结直肠腺瘤是安全且有效的。混合-EFTR在选定的患者中显著扩大了EFTR的适应症。版权所有©2023年美国消化内镜学会。由爱思唯尔股份有限公司出版。保留所有权利。

Endoscopic full-thickness resection (EFTR) with the full-thickness resection device (FTRD) has become the standard technique for selected non-lifting colorectal adenoma but tumor size is the major limitation. However, large lesions might be approached in combination with endoscopic mucosal resection (EMR). Herein, we report the largest single-center experience to date of combined EMR/EFTR (Hybrid-EFTR) in patients with large (≥ 25 mm) non-lifting colorectal adenoma not amenable to EMR or EFTR alone.This is a single-center retrospective analysis of consecutive patients who underwent Hybrid-EFTR of large (≥ 25 mm) non-lifting colorectal adenoma. Outcomes of technical success (successful advancement of the FTRD with consecutive successful clip deployment and snare resection), macroscopic complete resection, adverse events and endoscopic follow-up were evaluated.75 patients with non-lifting colorectal adenoma were included. Mean lesion size was 36.5 mm (range 25-60 mm) and 66.6 % were located in the right-sided colon. Technical success was 100 % with macroscopic complete resection in 97.3 %. Mean procedure time was 83.6 minutes. Adverse events occurred in 6.7 % leading to surgical therapy in 1.3 %. Histology revealed T1 carcinoma in 16 %. Endoscopic follow-up was available in 93.3 % (mean follow-up time: 8.1 months, range 3-36 months) and showed no signs of residual or recurrent adenoma in 88.6 %. Recurrency (11.4 %) was treated endoscopically.Hybrid-EFTR is safe and effective for advanced colorectal adenoma which cannot be approached by EMR or EFTR alone. Hybrid-EFTR expands the indication of EFTR substantially in selected patients.Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.