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Small bowel polyps in Peutz-Jeghers syndrome: management by combined push enteroscopy and intraoperative enteroscopy
1Gastroenterology-Gastrointestinal Endoscopy Service, Department of Oncology, S. Giovanni A.S. Hospital, Turin, Italy.
Insights
Effective small bowel polyp clearance using enteroscopy can reduce emergency surgeries for Peutz-Jeghers syndrome patients. This approach helps manage polyps and prevent complications in the small intestine.
Area of Science:
- Gastroenterology
- Medical Genetics
- Surgical Innovation
Background:
- Peutz-Jeghers syndrome is characterized by gastrointestinal polyps, with the small bowel posing significant management challenges.
- Small bowel polyps in Peutz-Jeghers syndrome can lead to complications requiring surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of enhanced endoscopic surveillance and polyp removal in managing small bowel polyps in patients with Peutz-Jeghers syndrome.
- To assess the impact of enteroscopy-guided polyp management on reducing the need for extensive small bowel resection.
Main Methods:
- A surveillance study of seven Peutz-Jeghers syndrome patients from 1979 to 1998.
- Implementation of enteroclysis, push enteroscopy, and intraoperative enteroscopy for polyp detection and removal starting in 1993.
- Periodic endoscopic follow-up and polyp management based on enteroclysis findings.
Main Results:
- Five of seven patients required emergency small bowel resection during the initial surveillance period.
- Patients with diffuse polyposis benefited from intraoperative and push enteroscopy, with significant polyp removal and asymptomatic follow-up.
- Patients with proximal small bowel polyps managed with periodic push enteroscopy remained asymptomatic, with substantial polyp burden reduction.
Conclusions:
- Enteroscopic clearance of small bowel polyps is effective in managing Peutz-Jeghers syndrome.
- Improved endoscopic techniques can decrease the necessity for emergency surgeries and extensive intestinal resections in these patients.
Background:
Polyps occur throughout the GI tract in Peutz-Jeghers syndrome; the major problem in the management of the syndrome lies in the small bowel.
Methods:
From January 1979 to January 1998, seven patients with Peutz-Jeghers syndrome underwent surveillance. Between 1979 and 1992 they were managed with upper and lower endoscopy every 2 to 3 years and surgery when intestinal obstruction occurred. From 1993 they also underwent enteroclysis and, on the basis of radiologic findings, push enteroscopy and/or intraoperative enteroscopy. Push enteroscopy was then performed every 2 years in all patients.
Results:
During the first period, 5 of 7 patients underwent emergency small bowel resection (2 operated twice). The patients were divided into 2 groups based on enteroclysis findings; the first comprised 4 patients with multiple polyps throughout the small bowel, and the second included 3 patients with polyps only in the proximal small bowel. Three of the 4 patients with diffuse polyposis underwent intraoperative enteroscopy during which on average 16 polyps per patient were removed (range 10 to 25 polyps; mean diameter 16 mm, range 3 to 50 mm). The remaining patient with diffuse polyposis had a single 25 mm polyp in the terminal ileum removed by retrograde ileoscopy; the more proximal polyps were removed by push enteroscopy. The patients with diffuse polyposis remained asymptomatic during follow-up (mean 50 months, range 47 to 57 months) and also underwent periodic push enteroscopy (mean 2.25 enteroscopies per patient, range 2 to 3) at which a mean of 8.5 polyps per patient (range 4 to 13 polyps) were removed (mean diameter 7.2 mm, range 3 to 15 mm). The 3 patients of the second group underwent periodic push enteroscopy alone (mean 3 per patient) during which a mean of 11.7 polyps per patient were removed (range 7 to 15 polyps: mean diameter 10.9 mm, range 3 to 40 mm). Enteroclysis was not repeated in these patients, who remained asymptomatic during follow-up (mean 47 months, range 46 to 48 months).
Conclusions:
More effective clearance of small bowel polyps via enteroscopy will help reduce the need for emergency surgery with extensive intestinal resection in patients with Peutz-Jeghers syndrome.