Introduction Endoscopic mucosal resection (EMR) is now the accepted first-line resection technique for large non-ampullary duodenal adenomas and are associated with significant adverse events. Aim of this series is to analyse EMR of duodenal adenomas in a tertiary centre. Methods Retrospective data was collected from October 2015 to August 2021 for patients who underwent duodenal EMR at a tertiary care centre. Patient's demographics, polyp morphology, procedural details, outcomes and histological data were analysed. Results Forty-five lesions required EMR in 35 patients (60% female). The mean adenoma size was 28.2 ± 20.3 mm (range 8–80 mm). Paris class IIa was noted in 68.89% (31/45); IIb in 15.56% (7/45),Is or Ip in 15.56% (7/45) procedures. Thirty-eight (84.45%) were laterally spreading tumours (LSTs) with 60.53% (23/38) non-granular and 39.47% (15/38) granular type tumours. Eleven patients (31.42%) had Familial Adenomatosis Polyposis (FAP) whilst the rest were sporadic. Piece-meal EMR was performed in 60% (27/45) and the remaining en-bloc. Argon plasma coagulation for tissue destruction at the edges of resection margins was used in 20% (9/45). Prophylactic haemostatic clips for closure of mucosal defect after EMR were deployed in 82.22% (37/45). Out of these, complete closure of the resection defect was successful in 27 (72.97%) procedures and in 10 (27.02%) with wide resection margins, haemoclips were deployed to reduce the size of the defect. Two (4.4%) post procedural bleeding occurred; one patient requiring surgical intervention and the other treated with endotherapy. At the median follow up of 23 months (range 3–58 months) recurrence was identified in 7.5% of cases. These patients achieved clinical success after a mean of 3.33 attempts (median 2, range 2–6). Risk factors for recurrence include size greater than 25 mm (p= 0.002), Paris IIa morphology (p=0.019), tubulovillous morphology(p=0.04) and piecemeal resection (p=0.02). Technical success was achieved in all procedures and clinical success in 34/35 (97.14%) patients with one patient referred for pancreas preserving total duodenectomy. Conclusion Endoscopic mucosal resection is a safe and effective primary treatment option for non-ampullary duodenal adenomas. Pre-emptive clip placement may protect against post procedural bleeding. Recurrent adenomas can be treated with further endotherapy.

Introduction Once mainstay of therapy, surgery has now been replaced by endoscopic ampullectomy, as the primary therapeutic modality for non-invasive ampullary adenomas. The present study aims to analyse endoscopic ampullectomy as a therapeutic approach in a large single-centre series. Methods This is a retrospective study of fifty consecutive patients who underwent endoscopic ampullectomy over an eleven-year period (January 2011 to December 2021) for ampullary adenomas. The analysis includes demographical features, diagnostic findings, technique of intervention (sedation choices, pre-intervention protocols, interventions), histology, technical, clinical success and adverse events. Results Fifty consecutive patients who underwent endoscopic ampullectomy during this period; with 27(54%) females and a mean age 67.62(+/- 12.13) years were included. Out of these, 44(88%) were sporadic and 6(12%) were Familial adenomatous polyposis (FAP) cases. Forty-two (84%) patients underwent pre-ampullectomy endoscopic ultrasound (EUS) evaluation. Pancreatic divisum was found in 6(12%) patients. Laterally spreading adenomas were seen in 15(30%) patients. In total, 35(70%) patients underwent ampullectomy under general anaesthesia, whereas in 15(30%) patients conscious sedation was used. Mean size of ampullary adenoma was 20.5mm (+/- 12.09mm, range 10–90mm). Single piece snare ampullectomy was performed in 33(66%) patients while remaining 17(34%) patients underwent piecemeal resection. Pancreatic stent placement as a prophylaxis against pancreatitis was achieved in 42(84%) patients and rectal Diclofenac was administered in 31(62%) patients. Bile duct stent placement was required in 21(42%) patients to prevent post-procedure cholangitis. Overall, in 20(40%) patients prophylactic haemoclip application to prevent post-procedure bleed was performed. Three patients were referred to surgery post ampullectomy for T2 adenocarcinoma, intraductal extension and high-grade dysplasia respectively. Overall, technical success was achieved in 46 (92%) patients while clinical success in 45(90%) patients. After a mean follow up was 20.84(+/-15.21) months (1–63 months), recurrence occurred in 4(8%) cases. All recurrences were treated endoscopically to eradication. Adverse events were noted in five (10%) patients; two (4%) each of pancreatitis and bleeding whilst one perforation occurred, requiring endoscopic clip closure. Conclusion Endoscopic ampullectomy is a safe and effective first line therapy for ampullary adenomas confined to mucosa. Meticulous patient selection through a multidisciplinary team approach, strict protocol-based management including endoscopic surveillance are essential for optimal outcomes.