Combined endoscopic and surgical treatment for the polyposis of Peutz-Jeghers syndrome

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Genetics

Background:

• Peutz-Jeghers syndrome (PJS) is associated with significant gastrointestinal polyposis, frequently leading to intussusception and necessitating repeated laparotomies.
• Extensive small bowel resections in PJS patients often result in short-bowel syndrome, severely impacting quality of life and requiring complex management.
• Current management strategies for PJS polyposis often involve surgical intervention, which carries risks of morbidity and further complications.

Observation:

• A novel combined surgical and endoscopic approach was utilized to manage gastrointestinal polyposis in a PJS patient.
• An intraoperative colonoscope was inserted via an enterotomy to visualize and access polyps throughout the small bowel.
• This technique allowed for the successful removal of multiple small polyps, preventing the need for further enterotomies.

Findings:

• Complete endoscopic polypectomy of 10 small polyps was achieved in a 20-year-old PJS patient.
• The intraoperative endoscopic intervention successfully averted multiple enterotomies and reduced the extent of necessary bowel resection segments.
• This approach demonstrated the feasibility of comprehensive polyp removal in the small bowel of PJS patients.

Implications:

• Aggressive management of polyposis in PJS through complete polypectomy can potentially lead to longer symptom-free intervals.
• Early and complete removal of polyps may reduce the risk of premalignant changes and associated complications.
• This minimally invasive endoscopic technique offers a promising strategy to improve long-term outcomes for PJS patients by preserving bowel length and function.