Comparison among Transanal Endoscopic Operation (TEO), Endoscopic Submucosal Dissection (ESD) and Full-Thickness Resection Device (FTRD) based on the Over-the-Scope (OVESCO) Clip System: which is the best technique for en bloc resection of rectal lesions?

INTRODUCTION Aim of Our retrospective study is comparing efficacy and indications of transanal endoscopic microsurgery (TEM), endoscopic submucosal dissection (ESD) and endoscopic full- thickness resection device (FTRD) with over-the-scope (OVESCO) closure for en bloc resection of rectal lesions, together. METHODS This study collected 76 cases of rectal neoplasms from a single hospital institution. Primary endpoints were complete en bloc resection, intraprocedural adverse events, R0 en bloc resection and an early discharge of the patient. Secondary endpoints included procedure-related adverse events. RESULTS Mean tumor sizes were statistically significant smaller among patients treated with FTRD rather than TEM and ESD. TEO and FTRD treated patients experienced a higher en bloc resection rate, with a shorter procedure time and hospital stay. No significant difference concerning the R0 resection was found. TEO and FTRD recorded lower perforation rates as compared to ESD, whereas no difference emerged concerning the bleeding rate and the post-polypectomy syndrome rate. CONCLUSIONS Our study showed that each technique has specific features, so that each one offers advantages and disadvantages. Nevertheless, all of them ensure high en bloc resection rates, whereas no difference exists for R0 resection rate. TEO provides the possibility to remove low rectal large lesions as compared to ESD and FTRD.