PTH-047 Polyloop assisted endoscopic resection of mega polyp arising in barrett’s oesophagus

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Abstract

Introduction

This case is a 72 year old male with 5 cm segment of Barrett’s oesophagus referred with a 4 cm polypoid lesion arising at the proximal end. Histology demonstrated low and high grade dysplasia, but CT staged as T1N1. After central MDT review an EUS and FDG-PET were ordered, and was staged at T1N1 by EUS but N0 by FDG-PET. The lesion was metabolically active. He was then referred for assessment of endoscopic therapy.

Method

Conscious sedation was used for the procedure (75mcg fentanyl, 3 mg midazolam). After lesion assessment using HD endoscopy and Narrow Band Imaging (Olympus), the lesion was assessed suitable for endoscopic resection, Paris Type 1p. Retroflexion view showed a floppy polyp, although the base appeared small. A polyloop was applied around the lesion. Then the snare from a Duette MBM kit (Cook) was used at 60W coag (ERBE) to remove the polyp above the loop in 2 sections. A loop cutter was used to cut down the loop to allow the MBM cap to fit over. A standard EMR band ligation technique was then employed, using 45W coag. No immediate complications were identified. The 3 pieces were then removed by a Roth net and sent for histology.

Results

Histology showed High grade dysplasia, with no evidence of cancer. Subsequently the patient has undergone Radiofrequency ablation, and although this was complicated by a stricture after the second treatment, this was easily treatable by balloon dilatation. Most recent biopsies have shown complete remission of dysplasia.

Conclusion

Complete resection of Type 1p oesophageal polyp of 4 cm is achievable using polyloop assisted EMR technique. Histology confirms an endoscopically curable lesion with no evidence of invasive cancer.

Disclosure of Interest

None Declared

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