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Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy
Filippo Torroni1, Erminia Romeo1, Francesca Rea1
1Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Insights
Single balloon enteroscopy effectively resects large polyps in Peutz-Jeghers syndrome (PJS) patients, preventing surgery. This prophylactic polypectomy offers a conservative first-line treatment for managing PJS small bowel polyps.
Area of Science:
- Gastroenterology
- Endoscopy
- Gastrointestinal Oncology
Background:
- Peutz-Jeghers syndrome (PJS) is associated with a high risk of gastrointestinal polyps.
- Large small bowel polyps in PJS patients can lead to complications like bleeding and intussusception.
- Surgical intervention is often considered for large polyps, carrying associated risks.
Purpose of the Study:
- To evaluate the efficacy of single balloon enteroscopy (SBE) in preventing surgical intervention for small bowel polyps in PJS patients.
- To assess the role of prophylactic polypectomy in managing large polyps (>15 mm) in PJS.
Main Methods:
- Seven asymptomatic PJS patients with small bowel polyps underwent wireless capsule endoscopy (WCE).
- Six patients with polyps >15 mm or prior GI tumors underwent SBE-guided prophylactic polypectomy.
- Procedures utilized antegrade approach with push-and-pull technique under general anesthesia.
Main Results:
- SBE successfully resected large polyps (20-50 mm) in 5 out of 6 patients.
- No surgical complications were reported; endoscopic clips were used in 2 cases.
- SBE prevented gastrointestinal bleeding and emergency laparotomy, avoiding intussusception.
Conclusions:
- Prophylactic polypectomy of large small bowel polyps (>15 mm) using SBE is an effective conservative treatment for PJS.
- SBE serves as a valuable tool to avoid surgical intervention in PJS patients with significant polyps.
- Regular endoscopic surveillance is crucial for PJS management.
Aim:
To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in patients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps.
Methods:
Seven consecutive asymptomatic pts (age 15-38 years) with PJS have been collected; six underwent polypectomy using single balloon enteroscopy (Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit (OBCU Olympus Balloon Control Unit) and a disposable silicone splinting tube with balloon (ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endoscopy (WCE). Prophylactic polypectomy was reserved mainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from -6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure.
Results:
Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm (range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgical resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussusceptions. No gastrointestinal tumors were found in subsequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper endoscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps (> 15 mm).
Conclusion:
The effective of prophylactic polypectomy of small bowel large polyps (> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.
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