Effectiveness of Double-balloon Enteroscopy-facilitated Polypectomy in Pediatric Patients With Peutz-Jeghers Syndrome
Dalia Belsha1, Arun Urs, Thomas Attard
1*Sheffield Children's Hospital, Western Bank, Sheffield, United Kingdom †Children's Mercy Hospital, Kansas City, MO.
Insights
Double-balloon enteroscopy (DBE) effectively removes large small-bowel polyps in children with Peutz-Jeghers syndrome (PJS). This minimally invasive approach offers a safe and successful alternative to surgery for managing PJS-related polyps.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Genetics
Background:
- Peutz-Jeghers syndrome (PJS) is associated with significant small-bowel (SB) polyp burden.
- Large SB polyps in PJS increase the risk of intussusception, often requiring invasive surgical intervention.
- Traditional management may involve laparotomy and intraoperative enteroscopy.
Purpose of the Study:
- To evaluate the efficacy and safety of double-balloon enteroscopy (DBE) for polypectomy in pediatric patients with PJS.
- To assess DBE as a therapeutic option for managing large SB polyps in this high-risk population.
- To determine the long-term outcomes of DBE-facilitated polypectomy in pediatric PJS.
Main Methods:
- Prospective analysis of data from pediatric patients with PJS undergoing DBE-facilitated SB polypectomy over six years.
- Inclusion of patients referred to a pediatric tertiary-referral center.
- Detailed recording of DBE procedures, polyp characteristics, and patient outcomes.
Main Results:
- Sixteen pediatric patients with PJS underwent 22 DBE procedures.
- Large polyps (≥1 cm) were present in 14 patients.
- Successful clearance of large SB polyps was achieved in all patients via DBE or laparoscopically assisted DBE (Lap-DBE).
- One patient experienced a post-Lap-DBE pelvic abscess; all others remained asymptomatic.
Conclusions:
- DBE-facilitated polypectomy is a safe and effective therapeutic strategy for pediatric patients with PJS.
- This technique offers a less invasive alternative for managing significant SB polyps.
- Early consideration of DBE in pediatric PJS patients is recommended.
Abstract:
Sizable small-bowel (SB) polyps in Peutz-Jeghers syndrome (PJS) pose a high risk for intussusception, often necessitating laparotomy and intraoperative enteroscopy. This series examines the effectiveness of double-balloon enteroscopy (DBE) facilitated polypectomy for pediatric patients with PJS. Prospective analysis of collected data (6 years) on all patients with PJS referred for DBE-facilitated SB polypectomy at a pediatric tertiary-referral center. A total of 16 pediatric patients with PJS were referred for DBE-facilitated SB polypectomy. Twenty-two DBEs were performed. Large polyps (≥1 cm) were confirmed in 14 patients. Successful clearance of large SB polyps by DBE or laparoscopically assisted DBE (Lap-DBE) was achieved in all patients. One patient experienced post-Lap-DBE pelvic abscess. All other patients remained asymptomatic and intervention free throughout follow-up (median 26 months). This series demonstrates that DBE-facilitated polypectomy is an effective therapeutic option in pediatric patients with PJS. It should be considered at an early age where possible.
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