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Endoscopic full-thickness resection reduces perforation risk and procedure time compared to endoscopic submucosal dissectionTrial shows EFTR reduces risks for certain colorectal lesions

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Key Takeaway
Consider EFTR for small or refractory colorectal lesions due to lower perforation risk and shorter procedure times.

This systematic review and meta-analysis evaluated 5 studies involving 570 patients to compare endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD) for colorectal lesions. The analysis focused on therapeutic efficacy, safety outcomes, and procedural efficiency.

Key findings indicate that EFTR is associated with significantly lower postoperative perforation risk (OR = 0.13; 95%CI 0.05 - 0.37; P < 0.001) and a lower incidence of post-polypectomy syndrome (OR = 0.23; 95%CI 0.08 - 0.68; P = 0.008) compared to ESD. Additionally, EFTR was associated with significantly shorter procedure times (SMD = -1.97; 95%CI -2.95 to -0.99; P < 0.001).

In contrast, several primary efficacy metrics showed no significant difference between the two methods: en bloc resection rates (OR = 2.59; P = 0.33), R0 resection rates (OR = 1.73; P = 0.23), postoperative bleeding (OR = 0.96; P = 0.94), and lesion recurrence rates (OR = 2.47; P = 0.13).

Clinically, EFTR may offer favorable short-term outcomes for specific small or refractory lesions, such as non-lifting or recurrent ones. However, ESD remains a standard for larger superficial colorectal neoplasia requiring en bloc resection. The evidence is based on a meta-analysis of 5 studies.

How this fits prior evidence

This finding addresses a gap in the comparative safety and efficiency profiles of endoscopic techniques for colorectal lesions. While prior coverage focused on image-enhanced endoscopy methods to improve adenoma detection rates, this meta-analysis provides specific data comparing EFTR and ESD. It confirms that while both techniques yield comparable resection success (en bloc and R0) and recurrence rates, EFTR offers a significant reduction in perforation risk (OR = 0.13) and procedure time compared to ESD.

Researchers analyzed data from 570 patients with colorectal lesions to compare two different removal techniques: endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD). The study looked at how well each method worked, how long they took, and the safety risks involved for the patients.

The results showed that both methods were comparable in terms of successful removal rates and bleeding. However, the EFTR technique was associated with shorter procedure times and a lower risk of perforation. It also showed a lower incidence of post-polypectomy syndrome compared to the ESD method.

Because this is a meta-analysis based on five studies, the findings are useful for understanding trends but do not prove one method is better for everyone. Doctors suggest that while EFTR shows favorable short-term outcomes for small or difficult lesions, ESD remains an important tool for larger superficial growths. Patients should talk to their doctors to determine which technique is best for their specific condition.

What this means for you:
EFTR may offer shorter procedure times and lower perforation risks for certain types of colorectal lesions.

Common questions

What are the main differences between EFTR and ESD?

Both methods were found to be comparable in terms of removal success, bleeding rates, and recurrence. However, the study found that EFTR resulted in shorter procedure times and a lower risk of perforation and post-polypectomy syndrome compared to the ESD method.

Is EFTR safer for certain types of lesions?

The study suggests EFTR may have favorable outcomes for small or refractory lesions, such as those that are hard to lift or have recurred. It showed a lower risk of perforation (OR 0.13) and less post-polypectomy syndrome (OR 0.23) than the ESD method.

Which treatment is best for large colorectal growths?

While EFTR shows benefits for specific small or difficult lesions, the study notes that ESD remains an essential and necessary tool for treating larger superficial colorectal neoplasia that require removal in one piece.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
ObjectiveTo conduct a systematic review and meta-analysis comparing the therapeutic efficacy of endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD) for colorectal lesions.MethodsA comprehensive search of PubMed, Web of science, Cochrane Library and Embase databases until October 1, 2025, supplemented by manual reference screening, identified studies comparing EFTR and ESD. Studies were selected based on predefined inclusion/exclusion criteria, with methodological quality assessed using standardized tools. Meta-analysis was performed using RevMan 5.4, calculating pooled odds ratios (OR) and standardized mean differences (SMD) with 95% confidence intervals.ResultsFive studies involving 570 patients were analyzed. EFTR and ESD showed comparable en bloc resection rates (OR = 2.59, 95%CI 0.38 ∼ 17.77, P = 0.33) and R0 resection rates (OR = 1.73, 95%CI 0.71 ∼ 4.20, P = 0.23). EFTR demonstrated superior safety profiles with significantly lower postoperative perforation risk (OR = 0.13, 95%CI 0.05 ∼ 0.37, P < 0.001), reduced post-polypectomy syndrome incidence (OR = 0.23, 95%CI 0.08 ∼ 0.68, P = 0.008), and shorter procedure time (SMD=-1.97, 95%CI -2.95 ∼ -0.99, P < 0.001). No significant differences were observed in postoperative bleeding (OR = 0.96, 95%CI 0.31 ∼ 2.94, P = 0.94) or lesion recurrence rates (OR = 2.47, 95%CI 0.76 ∼ 8.01, P = 0.13).ConclusionsIn summary, EFTR yields favorable short-term outcomes for selected small or refractory colorectal lesions, particularly non-lifting or recurrent lesions, whereas ESD remains essential for larger superficial colorectal neoplasia requiring en bloc resection.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42024534672.
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