Long-term results of polyp clearance by intraoperative enteroscopy in the Peutz-Jeghers syndrome

Area of Science:

• Gastroenterology
• Surgical Oncology
• Genetics

Background:

• Peutz-Jeghers syndrome is an inherited disorder characterized by polyps in the gastrointestinal tract.
• Frequent polyp formation necessitates repeated surgical interventions, often laparotomies, to manage complications and prevent malignancy.
• Traditional palpation and transillumination during laparotomy may miss small or impalpable polyps.

Purpose of the Study:

• To evaluate the efficacy of intraoperative enteroscopy in improving polyp clearance for patients with Peutz-Jeghers syndrome.
• To assess the impact of intraoperative enteroscopy on reducing the frequency of subsequent laparotomies.

Main Methods:

• A retrospective review of patients with Peutz-Jeghers syndrome who underwent intraoperative enteroscopy since 1987.
• Comparison of polyp detection rates between palpation/transillumination and enteroscopy.
• Analysis of subsequent laparotomies, including indications and timing, before and after the introduction of intraoperative enteroscopy.

Main Results:

• Intraoperative enteroscopy identified a median of 12 additional polyps per patient, all of which were removed.
• No patient required operative polypectomy within 4 years after enteroscopy-assisted clearance, compared to 17% in the pre-enteroscopy era.
• Six patients required subsequent laparotomies for various reasons, including one for perforation post-polypectomy.

Conclusions:

• Intraoperative enteroscopy enhances polyp clearance in Peutz-Jeghers syndrome patients.
• This minimally invasive approach during laparotomy may decrease the need for future abdominal surgeries.
• Improved polyp management through intraoperative enteroscopy offers better long-term outcomes.