Double-balloon endoscopy in patients with Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is a rare hereditary syndrome characterized by mucocutaneous pigmentation and hamartomatous polyps of the gastrointestinal tract, especially in the small intestine. Double-balloon endoscopy is a new endoscopic technique that enables both endoscopic visualization of the entire small bowel and therapeutic interventions in a single procedure. In this study, we evaluate the efficacy and safety of double-balloon endoscopy for both treatment and surveillance of patients with Peutz-Jeghers syndrome.

We retrospectively evaluated 7 consecutive patients who were referred to Dokuz Eylül University, Gastroenterology Department, with the diagnosis of Peutz-Jeghers syndrome between 2007 and 2010.

Patients with Peutz-Jeghers syndrome (M/F: 5/2) underwent a total 31 double-balloon endoscopy procedures: 21 by the oral route, 9 by the anal route, and 1 intraoperatively. All of the patients had a history of laparotomy and small bowel resection due to complications such as invagination and ileus. In 7 patients, we found a total of 110 polyps ≥10 mm in diameter (10-100 mm) and polypectomies were performed in all of them. The only complication was a bleeding after polypectomy, which was controlled by sclerotherapy. In 1 patient, because of the intraabdominal adhesions due to past laparotomies, polypectomy was done by intraoperative endoscopy. In 2 of our patients, we made surveillance colonoscopies, found new polyps in the small intestine, and performed polypectomies.

Double-balloon endoscopy is an effective and safe endoscopic technique, and represents a milestone for both treatment and surveillance of patients with Peutz-Jeghers syndrome. Polypectomies made in the small intestine might decrease the complication rate due to these polyps and the need for surgery.