P243 Non-ampullary sporadic duodenal adenomas – time for a consensus on endoscopic resection?

Introduction Sporadic duodenal adenomas (SDAs) are a rare but important finding at gastroscopy due to their malignant potential. Although endoscopic resection (ER) is generally advocated this carries significant risk related to the relatively thin, vascular and fixed duodenal wall. The lack of guidelines related to SDAs leads to variability in their management with potential implications for patient outcomes. This descriptive study aimed to evaluate current practice regarding the management of non-ampullary SDAs and assess the need for a consensus. Methods 40 internationally renowned advanced endoscopists from multiple international centres were surveyed regarding their management of non-ampullary SDAs. 12 questions investigating factors influencing whether to offer ER, pre-ER work-up, procedural risk and post-ER management were evaluated. Results The survey was completed by 19 endoscopists with 18 confirming they endoscopically manage non-ampullary SDAs. Most endoscopists offered ER on a case-by-case basis with patient age (72%), comorbidities (44%) and lesion size (39%) reported as integral to decision making. No guidelines were used by 94% but multi-disciplinary team discussion prior to ER was arranged routinely by 67% and in select cases by 22% of endoscopists. Endoscopists completed further investigation prior to ER including endoscopic ultrasound (39%) and cross-sectional imaging (22%). The degree of risk involved in duodenal resection quoted to patients including haemorrhage (range 1–50%, median 15%) and perforation (0.7–10%, median 3%) was variable. Both anti-coagulation and anti-platelets were restarted a median of 3 days (IQR 2–7 days) following duodenal resection. Post-procedural proton pump inhibitors (PPIs) were routinely prescribed by 94% of endoscopists however therapy duration was variable (median 29 days, IQR 14–30 days). Post-procedure patients were admitted routinely by 39% and in specific cases by 56% of endoscopists. Two endoscopists reported prescribing rectal non-steroidal anti-inflammatory drugs following ER of D2 adenomas. Conclusions There is widespread variability in the pre- and post-procedural management of non-ampullary SDAs in major international centres. The majority of endoscopists manage patients on a case by case basis following MDT discussion and advocate PPI therapy post resection. There is a need to develop a consensus of opinion to help standardise the management of non-ampullary SDAs