22: Unexpected upper gastrointestinal polyps in patients with short bowel syndrome treated with teduglutide: need for a close monitoring

Introduction: Short bowel syndrome with intestinal failure (SBS-IF) requires use of parenteral support (PS) and highly impacts patients quality of life. Teduglutide (TED), a GLP-2-analog, has proven efficacy reducing the need for PS. After the publication of two case reports describing the development of duodenal and jejunal polyps in patients with SBS treated with TED (Ukleja 2018, Pevny 2020), we aimed to verify this risk in a cohort of SBS patients treated with TED in an expert center of chronic intestinal failure. Methods: A retrospective study was conducted in 35 SBS patients treated with teduglutide for at least one year in a home parenteral nutrition expert center. All patients underwent at least one follow-up intestinal endoscopy during treatment. The lesions observed were described. Results: In the 35 patients, the small bowel length was 74 cm [IQR 25-100], and 23 patients (66%) had a colon in continuity. Upper and lower gastrointestinal endoscopy was performed after a mean treatment duration of 23 months [IQR 13-27] and found a polypoid lesion in 10 patients (6 with a colon in continuity, 4 with an end-jejunostomy) and no lesion in 25 patients. In 8 out of these ten patients, the lesion was found in the small bowel. Five of these lesions presented an aspect of hyperplastic polyp without dysplasia, and three of a traditional adenoma with low-grade dysplasia. The clinical characteristics of these patients and their lesions are summarized in the table below. Conclusion: Our study highlights the importance of performing follow-up upper and lower gastrointestinal endoscopy in SBS patients treated with teduglutide, and the potential need to make changes to the recommendations with respect to treatment initiation and follow-up.References: Pevny S et al. De Novo Development of Distal Jejunal and Duodenal Adenomas After 41 Months of Teduglutide Treatment in a Patient With Short-Bowel Syndrome: A Case Report. JPEN J Parenter Enteral Nutr. 2021 Mar;45(3):652-656. Ukleja A et al. De Novo Development of Hamartomatous Duodenal Polyps in a Patient With Short Bowel Syndrome During Teduglutide Therapy: A Case Report. JPEN J Parenter Enteral Nutr. 2018 Mar;42(3):658-660. SB: short bowel; CIPO: chronic intestinal pseudo-obstruction (Hirschsprung disease); AMI: arterial mesenteric ischemia; JCA: jejunocolic anastomosis; HP: hyperplastic polyp; FH: fundic heterotopia; TA: traditional adenoma; LGD: low-grade dysplasia; HGD: high-grade dysplasia