SAFETY OF COLD SNARE POLYPECTOMY FOR DUODENAL ADENOMAS IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS: PRELIMINARY RESULTS OF A PROSPECTIVE COHORT STUDY

Aims Duodenal adenomas occur in up to 90% of patients with familial adenomatous polyposis (FAP), and patients with advanced-stage duodenal adenomas had a quite high risk of developing duodenal cancer (7%-36%). Cold snare polypectomy (CSP) for multiple duodenal adenomas in patients with FAP was feasible in a prospective pilot study, and a prospective cohort study to investigate the efficacy (down staging of Spiegelman score) is ongoing. The aim of the present study is to confirm the safety of this procedure in a large cohort.

Methods This is a preliminaly analysis of a single center prospective cohort study including consecutive patients with FAP and multiple duodenal adenomas. Patients underwent CSP for multiple duodenal adenomas. Backgrounds of the participants, procedural outcomes and adverse events related to the procedure was assessed.

Results 59 patients [median (range) age: 37 (20-70), 29 male (49%)] were enrolled and two of them did not undergo CSP because they underwent papillectomy or underwater endoscopic mucosal resection. Therefore, CSP was performed for 57 patients with 2406 [median (range) number of polyps in each patient: 39 (5-166)] duodenal polyps from June 2016 to March 2019. The median (range) procedure time was 33 (15-96) minutes. 17 (30%) patients had polyps in 1^st part of the duodenum, 56 (98%) in 2^nd part, and 36 (63%) in 3^rd part. Median (range) size of maximum and minimum removed polyp in one session was 10 (2-50) and 2 (1-12), respectively. One patient developed arterial bleeding during the procedure, but the bleeding was managed using hemoclips but none of the 57 patients had perforation and delayed bleeding.

Conclusions The safety of CSP for multiple duodenal adenomas in patients with FAP was confirmed in a large cohort. The long-term efficacy of this procedure will be reported after 1-year follow-up.