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PTH-047 Polyloop assisted endoscopic resection of mega polyp arising in barrett’s oesophagus
  1. JM Dunn
  1. Gastroenterology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK

Abstract

Introduction This case is a 72 year old male with 5 cm segment of Barrett’s oesophagus referred with a 4 cm polypoid lesion arising at the proximal end. Histology demonstrated low and high grade dysplasia, but CT staged as T1N1. After central MDT review an EUS and FDG-PET were ordered, and was staged at T1N1 by EUS but N0 by FDG-PET. The lesion was metabolically active. He was then referred for assessment of endoscopic therapy.

Method Conscious sedation was used for the procedure (75mcg fentanyl, 3 mg midazolam). After lesion assessment using HD endoscopy and Narrow Band Imaging (Olympus), the lesion was assessed suitable for endoscopic resection, Paris Type 1p. Retroflexion view showed a floppy polyp, although the base appeared small. A polyloop was applied around the lesion. Then the snare from a Duette MBM kit (Cook) was used at 60W coag (ERBE) to remove the polyp above the loop in 2 sections. A loop cutter was used to cut down the loop to allow the MBM cap to fit over. A standard EMR band ligation technique was then employed, using 45W coag. No immediate complications were identified. The 3 pieces were then removed by a Roth net and sent for histology.

Results Histology showed High grade dysplasia, with no evidence of cancer. Subsequently the patient has undergone Radiofrequency ablation, and although this was complicated by a stricture after the second treatment, this was easily treatable by balloon dilatation. Most recent biopsies have shown complete remission of dysplasia.

Conclusion Complete resection of Type 1p oesophageal polyp of 4 cm is achievable using polyloop assisted EMR technique. Histology confirms an endoscopically curable lesion with no evidence of invasive cancer.

Disclosure of Interest None Declared

  • Barrett’s Oesophagus
  • endoscopy

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