RISK FOR SURGERY IN PATIENTS WITH POLYPOSIS SYNDROME AFTER DEVICE ASSISTED ENTEROSCOPY(DAE): LONG TERM FOLLOW-UP

Aims The aim of this study is to evaluate the efficacy of DAE in detection and treatment of small bowel polyps to reduce the risk of surgery. Secondary objectives are complications and mortality.

Methods We conducted a retrospective cohort study analyzing a structured database. Between September 2006 and October 2019, we observed 42 consecutive patients with polyposis syndromes and who underwent DAE,3 were excluded for elective surgery after enteroscopy. Endoscopic exams were performed with Single Balloon Enteroscope(Olympus) or with Spiral Motorized Enteroscope (Olympus).Polyps were distinct in small (< 10mm), medium (>10mm, < 20mm) and large (>25mm). The exams were performed with diagnostic and therapeutic purpose.

Results 39 patients were evaluated with an average follow up of 6.71yrs. (± SD 2.76), 79,5% were female, mean age was 43.8 yrs (± SD 15.02). A total of 68 enteroscopies were performed, both for oral and anal access. Therapeutic exams were 24 with removal of 64 polypoid lesions, most classified as small polyps (70,7%). One bleeding episode occurred after operative enteroscopy, needing 1 red blood cell transfusion. The need for surgery occurred in 6 patients with PJ and in 5 patients with FAP. The surgical indications in PJ patients were large polyps (3 patients) and 3 intussusception, 1 of these was a patient with a polyp in proximal ileum not reached with the scope. 1 patient with PJ died for pancreatic cancer during the follow up. The surgical indications in patients with FAP were 4 large polyps with High Grade Dysplasia and 1 ampullary neoplasia recurrence.

Conclusions In PJ patients endoscopic treatment of small bowel polyps was safe. In a long follow up period the patients with successful endoscopic treatment did not needed surgery, when occurred a failure in endoscopic treatment there was surgery recurrence. In FAP patients after DAE none developed a cancer.