PTH-039 Endoscopic mucosal resection of duodenal adenomas: success, complications, recurrence, surgery-free outcomes in a UK tertiary-centre

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Abstract

Background

Duodenal adenomas consist of sporadic and familial adenomatous polyposis (FAP) associated adenomas. Endoscopic mucosal resection (EMR) is the recognised technique when considering endoscopic removal of these lesions, but outcomes from large studies are lacking. Leeds Teaching Hospitals (LTHT) is a large tertiary centre that has a local catchment area of more than 8 00 000 people, and to our knowledge this is the largest UK cohort assessing duodenal EMR outcomes.

Methods

Retrospective data collection was performed of all patients who underwent duodenal EMR over a 17 year period at LTHT. We collected data on patient demographics, lesion characteristics and outcomes including significant complications, recurrence and surgery-free survival. Procedures were performed by a single advanced therapeutic endoscopist or an endoscopy fellow under supervision.

Results

A total of 98 patients underwent EMR (sporadic n=23, FAP n=75). Median adenoma size was 12.5 mm (IQR 9.0–30.0 mm), with 46.9% removed en-bloc. Standard EMR was performed in 87 procedures, and ‘pull-within snare’ technique in the remaining 11 procedures. Final lesion histology was TA/TVA with LGD (n=80), TA/TVA with HGD (n=12), intra-mucosal cancer (n=3) and in 3 cases data was missing. Patients with FAP were significantly younger with a median age of 49 years (p<0.001).

Results

The overall complication rate was 12.4%. One (1.0%) patient had an intra-procedural bleed which could not be managed endoscopically, delayed bleeding occurred in 6 cases (6.2%) and perforation occurred in 5 cases (5.2%), 3 (3.1%) of which could not be managed endoscopically. Following univariate analysis, ‘pull-within snare’ technique (p=0.03), piecemeal resection (p=0.002), and increasing polyp size (p=0.003) were significantly associated with complications. Adenoma recurrence at first follow up was 25.0%.

Results

Surgery was required in 6 patients (6.2%) within 24 months of their EMR, 4 (4.1%) cases for adenomas >30 mm, 2 (2%) cases for 10–29 mm and no cases for adenomas <10 mm.

Conclusion

This is the largest cohort in the UK pertaining to duodenal EMR outcomes, with success, recurrence and complications similar to other world leading endoscopy centres. Adverse outcomes are associated with increasing lesion size, piecemeal resection and EMR technique.

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