Endoscopy 2018; 50(04): S92
DOI: 10.1055/s-0038-1637301
ESGE Days 2018 oral presentations
21.04.2018 – Upper GI: resection session 2
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC MUCOSAL RESECTION OF SPORADIC NON-AMPULLARY DUODENAL ADENOMA: A DECADE OF EXPERIENCE FROM A TERTIARY REFERRAL CENTRE

K van Boxtel
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
M San Juan Acosta
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
S Beg
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
J Ortiz Fernández-Sordo
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
A Parra-Blanco
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
K Ragunath
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Endoscopic Mucosal Resection (EMR) offers a minimally invasive approach to the management of sporadic non-ampullary duodenal adenomas. However, there is limited data in Europe on the safety and efficacy. We aimed to describe the largest European experience from a tertiary referral centre.

Methods:

Review of the Endoscopy database of all patients with non-ampullary duodenal adenomas from 2005 – 2017 at a tertiary referral centre (Nottingham University Hospitals, United Kingdom) was performed. Patient demographics, lesion characteristics, procedural data, adverse events and follow-up data were collected.

Results:

Sixty-four patients underwent EMR for non-ampullary duodenal adenomas (mean age 69 years (32 – 85), male 56.3%). Mean size 22 ± 13 mm, most 0-IIa and 0-Is lesions according to the Paris Classification, 62.5% and 23.4% respectively. Histopathology was adenoma with low-grade dysplasia in 54 (84.3%) and adenoma with high-grade dysplasia in 3 patients (4.7%). Adenocarcinoma was found in 1 patient (1.6%), requiring additional surgical resection. At the first follow-up endoscopy in 3 – 6 months residual adenoma was identified and endoscopically treated in 7 of 50 (16%) patients, 4 patients required surgery and 3 patients were lost to follow up. Finally a total of 41 of 43 patients (95%) were free of adenoma tissue and considered cured, after a median follow-up period of 8 months. Intraprocedural bleeding occurred in 13/64 patients (20.3%, mostly minor oozing) and delayed bleeding in 2 cases (3.1%), all were managed successfully with endoscopic intervention. Perforation was noted in 2 patients (3.1%), in which conservative treatment was sufficient. Post-EMR stricture developed in 2 patients (3.1%) who had widespread resection. Treatment with repeated balloon dilatation was unsuccessful and these patients required surgery.

Conclusions:

Endoscopic resection of sporadic non-ampullary duodenal adenoma is a safe and effective alternative to surgery in a tertiary referral centre. Intraprocedural bleeding is common but can be successfully treated endoscopically.