Introduction Endoscopic 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.
Method A 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.
Results Sixty-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%).
Conclusion Endoscopic 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 common but can be successfully treated.
Disclosure of Interest None Declared
- duodenal polyps