Tu1489 ENDOSCOPIC SUBMUCOSAL DISSECTION OF DUODENAL LESIONS: A SINGLE CENTER EXPERIENCE

Abstract

Endoscopic submucosal dissection (ESD) has revolutionized the approach and treatment of gastrointestinal lesions, particularly the colon and stomach. In these locations, this technique has been proven to be safe with efficacy ad low recurrence rate. However, ESD in the duodenum is less common due to technical challenges with duodenal lesions. We herein present a single center US series of ESD for duodenal lesions. We performed a retrospective review of prospectively collected data on patients who underwent ESD of lesions in the duodenum between 01/2016 and 10/2019. Baseline data was collected for age, sex, prior EMR attempts, lesion location, and procedural related data. Primary outcomes included technical success, defined as successful en-bloc complete resection, R0 resection rate and intra/post procedural adverse event rates. Secondary outcomes included local recurrence rate. Mean with standard deviations were calculated for continuous data, while percentages were calculated for categorical data. Ten consecutive patients underwent duodenal ESD by an experienced endoscopist Table 1]. Mean age was 63 +/- 9 years, 50% were female. The duodenal bulb was the most common site for ESD (60%). Mean lesion diameter was 26.4 (+/- 28) mm. En-bloc resection and R0 resection rates were 100% and 100% respectively. 80% of post ESD defects were successfully closed, with an endoscopic suturing device being the most commonly employed method of closure (75%). Mean procedure time was 110 +/- 39.8 minutes. There were no intraprocedural complications encountered. The most common pathology was neuroendocrine tumor (60%). Two patients (20%) had post procedural bleeding within one week, both required repeat EGD with hemostasis. None of the patients with endoscopic suturing for defect closure had post-procedural bleeding. Sixty percent of patients presented for follow up at mean 165 (+/- 66) days with no evidence of recurrence on endoscopic or histologic evaluation. Duodenal ESD can be performed safely and effectively with a low serious adverse event rate and low risk of recurrence. Duodenal defect closure is important to prevent complications such as delayed perforation and hemorrhage.