UEGJournal Abstracts 2021 - 27

OP027
AMPULLARY ADENOMAS IN PATIENTS WITH FAMILIAL ADENOMATOUS
POLYPOSIS (FAP): BIOPSY, MANAGEMENT, RISK ASSESSMENT
R. Hüneburg1
C. Strassburg1
1
, C. Gorse1, D. Heling1
, J. Nattermann1
, T. Marwitz1, D.J Kaczmarek1
,
K. Takizawa1,2
University Hospital Bonn, Department of Internal Medicine I /
National Center for Hereditary Tumor Syndromes, Bonn, Germany
Contact E-Mail Address: robert.hueneburg@ukbonn.de
Introduction: Patients with familial adenomatous polyposis (FAP) are advised
to undergo risk-reducing prophylactic colonic surgery. After colectomy
has been performed, ampullary and duodenal cancer are the leading
causes of death. Risk stratification of duodenal polyposis and the assessment
of cancer risk is based on Spigelman stage. International guidelines
recommend endoscopic surveillance of the duodenum and visualisation
of the papilla to stage duodenal polyposis. It is not defined, whether the
papilla is part of the Spigelman staging system. Furthermore, there is no
consensus on routine biopsy of the papilla and inclusion of the results in
Spigelman stage.
Aims & Methods: We identified consecutive patients with FAP at a single
center from January 2012 till September 2020 with at least one upper GI
endoscopy. Patients with a forgegut surgery (Whipple procedure or pancreas-sparing
duodenectomy) were excluded. All patients were enrolled
in our prospective hereditary cancer registry and signed an informed consent.
We collected demographic, endoscopic and histology data and calculated
Spigelman stage with and without papilla results. Side effects of
ampullary biopsy were documented.
Results: A total number of 213 patients with FAP were part of our prospective
registry. We had to exclude 19 patients due to prior upper GI surgery.
In 193 patients (103 female; mean age 36.6 (+/- 16 y)) out of 213 at least
one upper GI endoscopy with ampullary biopsy was performed at our
department. In 189/193 (98%) a pathogenic variant in the APC gene was
documented. A total number of 218 ampullary biopsies were done in 193
patients. In 89/193 patients (46%) an ampullary adenoma was detected.
In 75/89 cases, an ampullary adenomas was mascroscopically suspected
and then confirmed by histopathological sampling. In 14/89 cases, the
ampullary adenoma was only detected via routine biopsy.
The inclusion of the histopathological result into the Spigelman score led
to an upgrade in 16 cases (7%), with consideration of prophylactic duodenectomy
for 2 patients (1%). No adverse events effects were observed
following ampullary biopsy.
The size of the ampullary adenoma led to an upgrade in 25 patients (28%)
and consideration of prophylactic duodenectomy in 4/89 patients (4%).
Four-teen patients underwent a papillectomy at our department. After
papillectomy, 6 cases of pancreatitis (42%) and four bleedings (28 %; endoscopically
managed) occurred. Follow-up data were available for all
patients. During follow-up, 6 out of 14 (43%) resection sites demonstrated
recurrence. In all six patients, additional EMR and radiofrequency ablation
were performed. In 4/6 (67%) patients, a pancreatitis was observed.
Conclusion: Biopsy of the ampulla is safe and feasible in FAP patients. The
histology data from the biopsy of the papilla can change Spigelman stage
and therefore affect patient management. Endoscopic papillectomies
showed substantial adverse events, especially interventional treatment
for recurrence. Benefits and risks should carefully be weighted.
Disclosure: Nothing to disclose.
T. Shimura15
2
, Y. Takeuchi3
T. Iwai5, T. Yamada6
A. Miyakawa10
, T. Ohta16
D-COP study Group
1
, M. Ohmori3
, T. Suzuki7
, H. Furuhashi11
, J. Fujisaki4
, M. Takeuchi8
, M. Matsuda12
, K. Mori17, H. Ishikawa18
, M. Yoshida9
, H. Araki13
, S. Yoshimizu4
,
, T. Gotoda19
, K. Ohno14
,
Sapporo Kinentou Hospital, Department of Gastroenterology
and Endoscopy, Sapporo, Japan, 3
Cancer Institute Hospital, Department of Gastroenterology,
Tokyo, Japan, 5Toyokawa City Hospital, Department of
Gastroenterology, Toyokawa, Japan, 6
,
Shizuoka Cancer Center, Division Of Endoscopy, Shizuoka, Japan,
Osaka International Cancer
Institute, Department of Gastrointestinal Oncology, Osaka, Japan,
4
Osaka Rosai Hospital,
Department of Gastroenterology, Sakai, Japan, 7
Center, Department of Endoscopy, Chiba, Japan, 8
10
Chiba Cancer
Nagaoka Red
Cross Hospital, Department of Gastroenterology, Nagaoka, Japan,
9
Shizuoka Cancer Center, Division of Endoscopy, Shizuoka, Japan,
Asahi General Hospital, Department of Gastroenterology, Chiba,
Japan, 11
of Endoscopy, Tokyo, Japan, 12
The Jikei University School of Medicine, Department
Toyama Prefectural Central
Hospital, Department of Gastroenterology, Toyama, Japan,
13
Nagoya City University Graduate School
Gifu University Hospital, Department of Endoscopy, Gifu, Japan,
14Shizuoka General Hospital, Department of Gastroenterology,
Shizuoka, Japan, 15
of Medical Sciences, Department of Gastroenterology and
Metabolism, Nagoya, Japan, 16
of Gastroenterology, Hyogo, Japan, 17
Clinical Trial Coordination Office, Shizuoka, Japan, 18
Kansai Rosai Hospital, Department
Shizuoka Cancer Center,
Kyoto
Prefectural University of Medicine, Department of MolecularTargeting
Cancer Prevention, Kyoto, Japan, 19
Nihon University
School of Medicine, Division of Gastroenterology and Hepatology,
Department of Medicine, Tokyo, Japan
Contact E-Mail Address: koh.takizawa@gmail.com
Introduction: Cold snare polypectomy (CSP) can minimize the risk of
adverse events and has become a standard treatment for subcentimeter
colorectal polyps. CSP might also be suitable for small superficial nonampullary
duodenal epithelial tumors (SNADETs). We conducted this multicenter
single-arm confirmatory trial (D-COP trial) to evaluate the safety
and efficacy of CSP for SNADETs (UMIN000030876).
Aims & Methods: The major indication criteria were: 1) endoscopically diagnosed
SNADET, 2) ≤10 mm, and 3) ≤ 3 target lesions. Patients with the
lesion endoscopically diagnosed as submucosal invasive cancer or familial
adenomatous polyposis were excluded. CSP was performed using an
electrosurgical snare without electrocautery. A follow-up endoscopy was
performed three months and 12 months after CSP. At 12months after CSP,
a biopsy from the CSP scar was planned even if there was no suspicious
sign of recurrence. The primary endpoint was the local recurrence rate
during 12 months after CSP.
The estimated sample size was tentatively set for 363 patients by estimating
that the rate of local recurrence in 12 months after CSP to be 7% or less
based on that in 12 months after EMR (3.4%), with an overall 2-sided alpha
level of 5% and a power of 80%.
Results: 408 patients with 430 lesions were enrolled from 86 institutions
(January 2018- February 2019). CSP was attempted 413 lesions in 395
patients. The median tumor size was 5 mm (range 2-10mm). About 84%
of them were located at the second part of the duodenum, and the most
common macroscopic type was superficially elevated (0-IIa, 67%). PreopVol.
9 | October 2021
27
,
OP028
COLD SNARE POLYPECTOMY FOR SUPERFICIAL NON-AMPULLARY
DUODENAL EPITHELIAL TUMOR: A MULTICENTER PROSPECTIVE
CONFIRMATORY TRIAL (D-COP TRIAL)
Tuesday, October 5, 2021
Monday, October 4, 2021
Sunday, October 3, 2021
UEGJournal Abstracts 2021

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