375 (Recurrent) Tubulovillous Adenoma of the Gastric Conduit Following Ivor Lewis Oesophagectomy

Abstract Case Report: This 79-year-old gentleman presented to clinic with a post-prandial cough. He was diagnosed with a tubulovillous adenoma (TVA) showing low grade dysplasia (LGD) of the oesophagus extending from 29-41cm on gastroscopy. His stomach and colon were clear of polyps. After further investigation including PET scan, the UGI MDT recommended Ivor Lewis Oesophagectomy rather than surveillance given the extent of adenomatous change. The patient underwent and recovered from surgery without complication. The histology specimen revealed a large polypoidal TVA with low grade and high grade epithelial dysplasia. Hybrid differentiation was noted to include both adenomatous type 1 intestinal and type 2 gastric foveolar dysplastic change. The proximal and distal donuts were negative, as were 48 lymph nodes. 18 months later, the patient's post-prandial cough returned. A repeat gastroscopy was performed, which identified a polypoidal lesion at the anastomosis between his native oesophagus and gastric conduit. Biopsies confirmed a recurrence of the TVA with LGD within the gastric conduit. This rare presentation had not been described in the literature before and so inter MDT discussions were held regarding the best method of treatment. A tree topping technique was used to debulk the large polypoidal lesion with hot snare endoscopic mucosal resection (EMR). The base was then visualised and able to be resected with conventional EMR. APC and PuraStat were applied to the base to good effect. The patient recovered well from this daycase procedure, performed under GA. He will continue to have close surveillance endoscopy.