This analysis aimed to evaluate the technical success, histological results, and safety profile of all eFTRs in the treatment of colorectal lesions in a tertiary referral center.

We retrospectively analyzed all consecutive colorectal eFTR procedures conducted between 2018 and 2025 at a single tertiary endoscopy center (Military University Hospital Prague, Czech Republic), using the full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Patient demographics, lesion characteristics, procedural data, histopathology, and adverse events (AEs) were extracted from a prospectively maintained database. Technical success was defined as en-bloc removal of the target lesion using the FTRD system. R0 resection required histologically tumor-free lateral and deep margins. Curative resection of invasive cancer followed ESGE low-risk criteria (R0, absence of lymphovascular invasion, and limited submucosal infiltration). AEs were defined as complications requiring endoscopic or surgical treatment. Proportions are reported with 95% confidence intervals (CI) using the Wilson or Clopper–Pearson method.

A total of 88 eFTR procedures were performed in 86 patients, 41 men (48%), and 45 women (52%); age range 26–86 years. The median lesion size was 20 mm (range, 10–30 mm). Lesion location was right colon 37 (42%), left colon 28 (32%), and rectum 23 (26%). Main indications were lesions suspicious for invasive cancer (36; 41%), non-lifting adenomas (21; 23.8%), recurrent adenomas (14; 16%), subepithelial tumors (5; 5.6%), scar after non-curative resection of T1sm1 cancer (9; 10.2%), and appendiceal lesions (3; 3.4%). En-bloc resection was achieved in 74/88 (84.1%; 95% CI, 75.0–90.3) and histological R0 in 71/88 (80.7%; 95% CI, 71.2–87.6). Invasive cancer was present in 34/88 (38.6%; 95% CI, 29.1–49.1). Among these cancers, R0 resection was achieved in 23/34 (67.6%; 95% CI, 50.8–80.9), with curative resection in 7/23 (30.4%; 95% CI, 15.6–50.9). AEs occurred in 11/88 (12.5%; 95% CI, 7.1–21.0): perforation (n=4), acute appendicitis (n=2), and bleeding (n=5). Three patients (3.4%) with delayed perforation required surgery.

In this single-center cohort, eFTR achieved high en-bloc and R0 resection rates with acceptable morbidity; most AEs were managed non-operatively. eFTR represents a valuable minimally invasive option for selected colorectal lesions, including non-lifting or recurrent adenomas and early cancer.

Funding: Supported by the Ministry of Health of the Czech Republic (NU22-08-00424) and Scientific projects MO1012 and Cooperatio