To analyse the efficacy and safety profile of eFTR in patients with complex colorectal lesions in a District General Hospital.

A retrospective analysis was carried out between 2021-2025. We identified 22 patients undergoing eFTR during this period. Data collected included patients' demographics, indications for eFTR, lesion size, and Charlson Comorbidity Score. Primary outcomes were defined as technical and histological success of R0 resection. Secondary outcomes included time from multidisciplinary team (MDT) discussion to eFTR, length of hospital stay, duration of the procedure, lesion site, complications and follow up, including recurrence rates. All patients referred to eFTR were discussed at our complex polyp MDT meeting.

The cohort consists of 17 males and 5 females. The median age was 75.5 years, with a median Charlson score of 6.0. Indications for eFTR included features of malignancy on superficial endoscopic assessment (n=11), benign polyps but morphologically suspicious for advanced histology (n=4), recurrent polyps (n=5), and submucosal lesions (n=2). The median lesion size was 17mm. Technical success was achieved in 20/22 cases (90.9%). Histological R0 resection was successful in 18 cases (81.8%) and R1 resection in 4 cases (18.2%). The median time from MDT discussion to eFTR was 25 days. Twenty-one cases (95.5%) were discharged on the same day, with one admission due to diabetic ketoacidosis unrelated to the procedure. The median duration of the procedure was 32 minutes. Of note, 16/22 cases were followed up, as the rest (n=6) were either managed conservatively (n=4), 

referred for chemotherapy (n=1) and lost to follow-up (n=1). One of the sixteen patients had a recurrence and was referred for surgery. There were no complications directly from eFTR.

EFTR is an effective, safe, and minimally invasive alternative procedure that can be used in managing complex colorectal lesions, including in elderly and frail patients, even in a District General Hospital setting, provided robust Governance and MDT processes are in place. We plan to longitudinally evaluate eFTR to further evaluate long-term outcomes in complex colorectal lesions.