PTH-068 Sporadic laterally spreading nonampullary duodenal adenomas: the role of saline-immersion therapeutic endoscopy

IntroductionSporadic laterally spreading nonampullary duodenal adenomas (SLSNDA) are an uncommon incidental finding during oesophagogastroduodenoscopy. Endoscopic mucosal resection (EMR) in the duodenum is challenging due to increased risk of perforation and bleeding. Underwater EMR (UEMR) is a novel and effective endoscopic resection technique performed without submucosal injection. Saline-immersion therapeutic endoscopy (SITE) is an evolution of UEMR and saline solution is used instead of water to minimise the risk of water intoxication.Aims and methodsOur aim was to evaluate the efficacy and safety of SITE-EMR for SLSNDA via a retrospective review of SLSNDA resected by SITE-EMR at our institution from May 2017 to October 2018. Demographic, clinical, endoscopic findings and follow-up data were analysed.ResultsNine SLSNDA (median size25 mm) were found in eight patients (4 male, median age: 69 year-old). One was located in D1, 4 in D2 and 4 in D3. En-bloc resection was achieved in two lesions (23%) while wide-field resection was performed in seven lesions (77%). Complete resection was achieved in seven patients (87.5%). A circumferential lesion involving the whole duodenal bulb was found in one case and SITE-EMR technique was not feasible as well as other alternative endoscopic resection techniques due to severe fibrosis; the patient was therefore referred for surgery and excluded from further analysis. Histological results revealed six (75%) tubulo-villous adenomas with low-grade dysplasia and two tubular adenomas low-grade dysplasia (25%). Immediate complications including perforation and bleeding did not occur. One patient (12.5%) presented with delayed GI bleeding 24hours post procedure and was treated successfully with endoclips. Three cases (37.5%) of recurrences were identified at 3 months follow-up requiring further endoscopic treatment. No further recurrence was identified at 6 and 12 months follow-up in any patient.ConclusionSITE-EMR of SLSNDA appears to be a safe and effective management with low recurrence rates at long term follow-up.