PWE-042 The endoscopic mucosal resection of large non-ampullary duodenal polyps: a decade of experience from a tertiary referral centre

IntroductionEndoscopic Mucosal Resection (EMR) offers a minimally invasive approach to the management of non-ampullary duodenal polyps. However, there is limited data from the Western world on safety, feasibility, outcomes and optimal management. We aimed to describe the largest European experience from a tertiary referral centre.MethodA database review of all patients referred with non-ampullary duodenal polyps from 2003 – January 2017 in a tertiary referral endoscopy centre (Nottingham University Hospital-United Kingdom) was performed. Patient demographics, lesion characteristics (size, location, Paris classification and histopathology), procedural data, first follow-up at a mean 4 months, second surveillance ≥12 months and adverse events were evaluated.ResultsSixty-one patients with non-ampullary duodenal polyps were identified. 58 patients (95%) underwent EMR [mean patient age 67±10 SD years (32-85), male 55.2%)] and 3 patients were referred for surgery. The mean polyp size was 20±12 mm. Paris classification 0-IIa and 0-Is was seen in 58.6% and 22.4% respectively. Complete resection in the first session was achieved in 54 of 58 patients (93.1%). Histologically proven adenoma recurrence was identified and endoscopically treated in 5 of 42 patients (11.9%) on first surveillance. 16 of the 19 patients who were followed up ≥12 months were free of adenoma and considered cured (84.2%). Post EMR stricture occurred in 2 of 58 patients (3.4%) who had widespread resection (>75% circumference). Treatment was attempted with endoscopic balloon dilatation but was unsuccessful and these patients required surgery. Intraprocedural bleeding was noted in of 16 of 58 patients (27.5%) and there was 1 case (1.7%) of delayed bleeding, which was managed successfully with endoscopic intervention. Perforation was noted in 1 patient (1.7%), conservative treatment was sufficient to manage this complication. The removed lesions were retrieved in 51 of 58 patients (87.9%). Histopathology was adenoma with low grade of dysplasia in 43 of 58 patients (74.1%), adenoma with high grade of dysplasia in 5/58 patients (8.6%), neuroendocrine tumour in 2/58 patients (3.4%), serrated lesion in 1 patient (1.7%).ConclusionEndoscopic resection of large non-ampullary duodenal polyp is a safe and effective alternative to surgery in a tertiary referral centre. However, widespread resection can result in refractory stricture that is difficult to manage endoscopically. Intraprocedural bleeding is comm