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Su1053 Long-term Outcomes of Endoscopic and Surgical Resection of Non-ampullary Duodenal Adenomas
SUNDAY ABSTRACTS
Su1052 Self Expandable Metal Stents (SEMS) As an Alternative Treatment Option in Perforated Duodenal Ulcers, Comparison With Surgery Jorge Alberto Arroyo Vázquez*1, Maria Bergström1,2, Per-Ola Park1,2 1 Dept of Surgery, South Alvsvorg Hospital, Boras, Sweden; 2Dept of Surgery, Gothenburg University, Gothenburg, Sweden Introduction: As an alternative to standard surgical treatment of perforated duodenal ulcers we have used placement of semi covered duodenal stents in selected cases. The objective of this study was to compare the new stent treatment method with the traditional surgical suture. Methods: All patients with perforated duodenal ulcer admitted to our hospital during 2009-2012 were included in a retrospective study. Age, ASA-score, method of treatment, complications and hospital stay were recorded. Surgery was performed with standard open or laparoscopic techniques. For stent treatment a partially covered duodenal stent (Hanaro, MI-tech) was placed over a guide wire through the gastroscope. A 9 cm long stent with the oral end placed in the antrum covered the perforation. Results: In total 29 patients were included. 19 of them had surgery, open or laparoscopic. 18 had simple sutured closure and one had a BII resection. 10 patients were treated with a partially covered duodenal stent, eight of these patients also received a percutaneous drain, either during diagnostic laparoscopy or placed by interventional radiologist. The median age in the surgical group was 77 years (43-95) with a mean ASA score of 2.5. The median age in the stent group was 79 years (62-87) with a mean ASA-score of 2.9. 6/19 patients in the surgical group had complications (1 abdominal compartment syndrome, 4 intra abdominal abscesses, 1 respiratory insufficiency, 1 sepsis). Two out of these patients died. In the stented group 1/10 patients had complications (1 intra abdominal abscess). One patient with multiorgan failure had a delayed diagnosis and was stented one week after admission. She died on day one post stenting. Median hospital stay was 10 days (5-72) in the surgical group and 17 days (9-36) in the stent group. There was no significant difference between the groups concerning age, ASAscore, complication rate or hospital stay. However, there was a tendency towards higher age, higher ASA-score and less severe complications in the stented group. There was no statistically significant difference between the complication rates. Patients with complications were significantly older (pZ 0.028) than those without. Conclusion: Stent treatment together with percutaneous drainage seems to be a safe and effective alternative to traditional surgical closure for treatment of perforated duodenal ulcer and might be an option in co-morbid or old patients.
Su1053 Long-term Outcomes of Endoscopic and Surgical Resection of Non-ampullary Duodenal Adenomas Noemi J. Baffy*1, Alaa El Chami1, Nina Ngo2, Amy F. Bevacqua1, Cuong C. Nguyen1 1 Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ; 2 Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ Background/Aims: Non-ampullary, sporadic duodenal polyps are detected in 0.3– 4.6% of upper endoscopy. There is paucity of information regarding their natural history and the long-term outcomes after endoscopic and surgical resection. Aim of this study was to review surveillance practices with non-ampullary duodenal adenomas to determine the frequency of malignant change, recurrence rates, the effect of treatment on recurrence, and association with other gastrointestinal malignancies. Methods: Patients with the histologic diagnosis of duodenal adenoma established during upper endoscopy were identified from a 2004-2015 centralized pathology database. Data were extracted regarding demographics, histology, size and location in the duodenum, type of endoscopic/surgical interventions, recurrence, and other co-existing digestive diseases and were analyzed using analyses of variance. Results: Of 495 pathology specimens from 260 unique patients, 151 (men: 93, 61%, Caucasians 144, 95%, mean age 70 years) were included in the analysis. Smoking and alcohol use was more prevalent in men (42.4% vs 11.9%; 60.8% vs 39.2%). At index procedure, tubular adenomas were the predominant subtype (nZ104), with dysplasia present in 8. Complete resection of the polyp was reported in half of the cases (nZ76, 50.3%). Surgical resection was more common with larger duodenal polyps (nZ35, mean 19.43 mm vs 6.98 mm; p<0.001). Endoscopic surveillance was performed for 92 (60.9%) patients with a mean number of EGDs totaling 3 (range 116) with no statistical significance (pZ0.4252) when compared with those who eventually underwent surgical resection. Repeat endoscopy was performed within 6 months in most cases (0-6 months: 64; 6-12 months:12; >12 months:16). The majority of patients demonstrated persistent adenomatous changes at first surveillance regardless of the surveillance interval (0-6 months: 31; 6-12 months: 7; >12 months: 9). Despite initial complete resection, adenomatous changes are noted on subsequent endoscopies, detailed in Table 1. A small number (nZ3) developed interval dysplasia and 1 patient was found to have carcinoma in situ at the second surveillance endoscopy. Personal or family history of adenomatous colon polyps or colorectal cancer was more common in those who had persistent adenomas identified at surveillance EGDs (pZ0.023). The average length of follow up including office visits
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was 36.29 months (range 1-178 months). Conclusion: Although rare, duodenal adenomas have the potential to develop dysplasia and eventually into carcinoma in situ. Currently, no surveillance recommendations exist and this retrospective analysis of surveillance practices highlights the persistence of adenomatous changes and the need for regular follow-up. Colorectal cancer screening should be recommended for all patients with duodenal adenomas. Table 1. Adenomatous changes on surveillance endoscopies 1st endoscopy 2nd endoscopy 3rd endoscopy 4th endoscopy 5th endoscopy Total number of patients with adenoma detected at any surveillance endoscopy
nZ31 nZ11 nZ7 nZ4 nZ2 31/76 (40.7%)
Su1054 Transoral Outlet Reduction for Therapy of Weight Regain After Gastric Bypass Rosario Landi*, Ivo Boskoski, Pietro Familiari, Andrea Tringali, Vincenzo Perri, Guido Costamagna Catholic University, Rome, Italy Background and Aim: Enlargement of gastrojejunal anastomosis aperture is associated with weight regain in patients with Roux-en-Y gastric bypass (RYGB). Endoscopic transoral outlet reduction (TORe) has proven safe and effective for treatment of weight regain. The objective of this study was to evaluate the results of endoscopic outlet reduction in single Italian center. Material and Methods: The series included consecutive post-RYGB patients with weight regain and enlarged gastrojejunal anastomosis aperture (>15 mm). Endoscopic reduction was performed with Overstitch (Apollo Endosurgery) which is a full-thickness endoscopic suturing device. All the procedures were done at the Digestive Endoscopy Unit of the Catholic University of Rome. Results: Nineteen patients who had weight regained after RYGB (BMI > 30) underwent TORe from January to September 2015. Baseline mean BMI was 36.8 (range 33-43.6) and weight was 104.5 kg (range 85-131). The procedure was done with the Overstitch and Olympus double channel operative endoscope. An Overtube was placed before the procedure in all patients. Before suturing the outlet rims were cauterized with pulsed pulsed Argon Plasma on 40 Watts in all patients. Mean procedure time was 35 minutes (range 15-60) and a mean number of 2.3 stitches per patient were placed (range 2-4) on the level of the gastric outlet. After suturing the patency of the new redone outlet was tested with standard gastroscope. There were three (15.7%) complications of which two were mild (1 intraoperative bleeding that arrested spontaneously and 1 patient with fever due to small retrogastric collection treated with antibiotics), while one patient (5.2%) had gastric perforation that required urgent surgery. Mean hospital stay was 2.8 days (range 2-10). Telephonic follow-up was done at 1, 3 and 6 months. Mean BMI at 1 month follow-up was 33.8, at 3 months was 32.4 while at 6 months was 32.3. Figure 1 shows the BMI during followup for each patient. Conclusions: In our experience TORe was safe and effective procedure in patients with weight regain after RYGB. Longer follow-up is needed to establish the durability of these results. Further studies are however needed to better understand the role of TORe after RYGB and the proper selection of patients.
Figure 1. BMI during follow-up for each patient.
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB311
Su1052 Self Expandable Metal Stents (SEMS) As an Alternative Treatment Option in Perforated Duodenal Ulcers, Comparison With Surgery Jorge Alberto Arroyo Vázquez*1, Maria Bergström1,2, Per-Ola Park1,2 1 Dept of Surgery, South Alvsvorg Hospital, Boras, Sweden; 2Dept of Surgery, Gothenburg University, Gothenburg, Sweden Introduction: As an alternative to standard surgical treatment of perforated duodenal ulcers we have used placement of semi covered duodenal stents in selected cases. The objective of this study was to compare the new stent treatment method with the traditional surgical suture. Methods: All patients with perforated duodenal ulcer admitted to our hospital during 2009-2012 were included in a retrospective study. Age, ASA-score, method of treatment, complications and hospital stay were recorded. Surgery was performed with standard open or laparoscopic techniques. For stent treatment a partially covered duodenal stent (Hanaro, MI-tech) was placed over a guide wire through the gastroscope. A 9 cm long stent with the oral end placed in the antrum covered the perforation. Results: In total 29 patients were included. 19 of them had surgery, open or laparoscopic. 18 had simple sutured closure and one had a BII resection. 10 patients were treated with a partially covered duodenal stent, eight of these patients also received a percutaneous drain, either during diagnostic laparoscopy or placed by interventional radiologist. The median age in the surgical group was 77 years (43-95) with a mean ASA score of 2.5. The median age in the stent group was 79 years (62-87) with a mean ASA-score of 2.9. 6/19 patients in the surgical group had complications (1 abdominal compartment syndrome, 4 intra abdominal abscesses, 1 respiratory insufficiency, 1 sepsis). Two out of these patients died. In the stented group 1/10 patients had complications (1 intra abdominal abscess). One patient with multiorgan failure had a delayed diagnosis and was stented one week after admission. She died on day one post stenting. Median hospital stay was 10 days (5-72) in the surgical group and 17 days (9-36) in the stent group. There was no significant difference between the groups concerning age, ASAscore, complication rate or hospital stay. However, there was a tendency towards higher age, higher ASA-score and less severe complications in the stented group. There was no statistically significant difference between the complication rates. Patients with complications were significantly older (pZ 0.028) than those without. Conclusion: Stent treatment together with percutaneous drainage seems to be a safe and effective alternative to traditional surgical closure for treatment of perforated duodenal ulcer and might be an option in co-morbid or old patients.
Su1053 Long-term Outcomes of Endoscopic and Surgical Resection of Non-ampullary Duodenal Adenomas Noemi J. Baffy*1, Alaa El Chami1, Nina Ngo2, Amy F. Bevacqua1, Cuong C. Nguyen1 1 Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ; 2 Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ Background/Aims: Non-ampullary, sporadic duodenal polyps are detected in 0.3– 4.6% of upper endoscopy. There is paucity of information regarding their natural history and the long-term outcomes after endoscopic and surgical resection. Aim of this study was to review surveillance practices with non-ampullary duodenal adenomas to determine the frequency of malignant change, recurrence rates, the effect of treatment on recurrence, and association with other gastrointestinal malignancies. Methods: Patients with the histologic diagnosis of duodenal adenoma established during upper endoscopy were identified from a 2004-2015 centralized pathology database. Data were extracted regarding demographics, histology, size and location in the duodenum, type of endoscopic/surgical interventions, recurrence, and other co-existing digestive diseases and were analyzed using analyses of variance. Results: Of 495 pathology specimens from 260 unique patients, 151 (men: 93, 61%, Caucasians 144, 95%, mean age 70 years) were included in the analysis. Smoking and alcohol use was more prevalent in men (42.4% vs 11.9%; 60.8% vs 39.2%). At index procedure, tubular adenomas were the predominant subtype (nZ104), with dysplasia present in 8. Complete resection of the polyp was reported in half of the cases (nZ76, 50.3%). Surgical resection was more common with larger duodenal polyps (nZ35, mean 19.43 mm vs 6.98 mm; p<0.001). Endoscopic surveillance was performed for 92 (60.9%) patients with a mean number of EGDs totaling 3 (range 116) with no statistical significance (pZ0.4252) when compared with those who eventually underwent surgical resection. Repeat endoscopy was performed within 6 months in most cases (0-6 months: 64; 6-12 months:12; >12 months:16). The majority of patients demonstrated persistent adenomatous changes at first surveillance regardless of the surveillance interval (0-6 months: 31; 6-12 months: 7; >12 months: 9). Despite initial complete resection, adenomatous changes are noted on subsequent endoscopies, detailed in Table 1. A small number (nZ3) developed interval dysplasia and 1 patient was found to have carcinoma in situ at the second surveillance endoscopy. Personal or family history of adenomatous colon polyps or colorectal cancer was more common in those who had persistent adenomas identified at surveillance EGDs (pZ0.023). The average length of follow up including office visits
www.giejournal.org
was 36.29 months (range 1-178 months). Conclusion: Although rare, duodenal adenomas have the potential to develop dysplasia and eventually into carcinoma in situ. Currently, no surveillance recommendations exist and this retrospective analysis of surveillance practices highlights the persistence of adenomatous changes and the need for regular follow-up. Colorectal cancer screening should be recommended for all patients with duodenal adenomas. Table 1. Adenomatous changes on surveillance endoscopies 1st endoscopy 2nd endoscopy 3rd endoscopy 4th endoscopy 5th endoscopy Total number of patients with adenoma detected at any surveillance endoscopy
nZ31 nZ11 nZ7 nZ4 nZ2 31/76 (40.7%)
Su1054 Transoral Outlet Reduction for Therapy of Weight Regain After Gastric Bypass Rosario Landi*, Ivo Boskoski, Pietro Familiari, Andrea Tringali, Vincenzo Perri, Guido Costamagna Catholic University, Rome, Italy Background and Aim: Enlargement of gastrojejunal anastomosis aperture is associated with weight regain in patients with Roux-en-Y gastric bypass (RYGB). Endoscopic transoral outlet reduction (TORe) has proven safe and effective for treatment of weight regain. The objective of this study was to evaluate the results of endoscopic outlet reduction in single Italian center. Material and Methods: The series included consecutive post-RYGB patients with weight regain and enlarged gastrojejunal anastomosis aperture (>15 mm). Endoscopic reduction was performed with Overstitch (Apollo Endosurgery) which is a full-thickness endoscopic suturing device. All the procedures were done at the Digestive Endoscopy Unit of the Catholic University of Rome. Results: Nineteen patients who had weight regained after RYGB (BMI > 30) underwent TORe from January to September 2015. Baseline mean BMI was 36.8 (range 33-43.6) and weight was 104.5 kg (range 85-131). The procedure was done with the Overstitch and Olympus double channel operative endoscope. An Overtube was placed before the procedure in all patients. Before suturing the outlet rims were cauterized with pulsed pulsed Argon Plasma on 40 Watts in all patients. Mean procedure time was 35 minutes (range 15-60) and a mean number of 2.3 stitches per patient were placed (range 2-4) on the level of the gastric outlet. After suturing the patency of the new redone outlet was tested with standard gastroscope. There were three (15.7%) complications of which two were mild (1 intraoperative bleeding that arrested spontaneously and 1 patient with fever due to small retrogastric collection treated with antibiotics), while one patient (5.2%) had gastric perforation that required urgent surgery. Mean hospital stay was 2.8 days (range 2-10). Telephonic follow-up was done at 1, 3 and 6 months. Mean BMI at 1 month follow-up was 33.8, at 3 months was 32.4 while at 6 months was 32.3. Figure 1 shows the BMI during followup for each patient. Conclusions: In our experience TORe was safe and effective procedure in patients with weight regain after RYGB. Longer follow-up is needed to establish the durability of these results. Further studies are however needed to better understand the role of TORe after RYGB and the proper selection of patients.
Figure 1. BMI during follow-up for each patient.
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB311