PWE-038 Endoscopic resection of ampullary and duodenal adenomas: a tertiary referral centre experience

IntroductionDuodenal and ampullary adenomas have the potential for malignant transformation to carcinomas by an adenoma-to-carcinoma sequence as seen elsewhere in the gastrointestinal tract. Endoscopic resection of these lesions is increasingly being used in place of invasive surgery. However, endoscopic resection in the duodenum can be challenging due to its anatomy and may be associated with a higher risk of complications. This study aims to evaluate the safety and efficacy of endoscopic resection of such lesions.MethodsAll patients with ampullary and large non-ampullary (>10 mm) duodenal polyps who underwent endoscopic resection between February 2008 and January 2019 in a single tertiary referral centre were included in the study. A retrospective analysis on data including demographics, size, histology, location, method of resection and complications was performed.ResultsThere were a total of 112 patients referred for endoscopic therapy. Of these 112 patients, 37 underwent ampullectomy and 85 patients were referred for resection of non-ampullary duodenal polyps > 10 mm.In patients who underwent ampullectomy, 27 (73%) had a submucosal injection, whereas pancreato-duodenal stent was placed in 26 (70%) of patients. 7 (20%) patients had adjunct tissue ablation (APC). 62% of the lesions were pure ampullary, whereas 38% polyps involved the duodenum.In the 85 patients who were referred with a non ampullary duodenal lesion, 58 (68%) underwent endoscopic mucosal resection (EMR) and 27 (32%) had knife assisted resection (KAR). Majority of the lesions (70) were found in D2 (82%).Further characteristics have been summarized in table 1Abstract PWE-038 Table 1 Non ampullary duodenal resections Ampullectomies Number 85 37 Median age 64 years [IQR 27–87] 66 years [IQR 50–83] Mean size 25.3 mm 21.6 mm Diagnosis of FAP 9.4% 13.5% En bloc resection 40% 43.2% Median follow up 38 months 16 months Recurrence 7% 24.3% Bleeding 8% 5.4% Perforation 2% 0% Lesions >30 mm 38% 32% All complications were managed endoscopicallyThe majority of the recurrences were treated successfully with subsequent endoscopic resection. No procedure related mortality was noted in this cohort.ConclusionsEndoscopic resection of duodenal and ampullary lesions is a safe and effective technique for complete removal of these polyps. The risk of complications is similar in ampullary and non-ampullary resections, however, the risk of recurrence is higher in patients with ampullary adenomas. Nevertheless, we