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High-Tech Diagnostic Methods and Enteroscopic Treatment of Children with Peutz-Jeghers Syndrome
Evgeniya Kirakosyan1, Maxim Lokhmatov2,3
1International School "Medicine of the Future", Sechenov University Faculty of Medicine, Moscow, Russia.
Insights
This study presents an optimal endoscopic method for diagnosing and treating Peutz-Jeghers syndrome (PJS) polyps in children. The technique successfully removed deep small intestine polyps, avoiding complications and bowel resection.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Hereditary Polyposis Syndromes
Background:
- Peutz-Jeghers syndrome (PJS) is an inherited disorder characterized by hamartomatous polyps, primarily in the small intestine.
- Traditional polypectomy carries a high risk of bowel perforation in PJS patients.
- Advanced enteroscopy is crucial for deep small intestine interventions.
Purpose of the Study:
- To develop an optimal diagnostic and therapeutic approach for managing polyps in pediatric PJS patients.
- To minimize the risk of postoperative complications, particularly bowel perforation.
Main Methods:
- A comprehensive examination protocol including esophagogastroduodenoscopy, colonoscopy, and video capsule endoscopy.
- Therapeutic single-balloon enteroscopy guided by initial imaging.
- A standardized polyp removal technique involving a "resistant pillow," electroexcision, and clipping.
Main Results:
- Successful electroexcision of large polyps (up to 2.5 cm) in the deep small intestine.
- The technique was effective for polyps with long pedicles.
- No postoperative complications, including delayed perforations, were observed.
Conclusions:
- The developed endoscopic method provides an optimal strategy for PJS polyp management in children.
- This technique significantly reduces the risk of postoperative small intestine perforations.
- Modern enteroscopy offers a viable alternative to surgical bowel resection for pediatric PJS patients.
Introduction:
Peutz-Jeghers syndrome (PJS) is an autosomal dominant hereditary hamartomatous polyposis with predominant localization in the jejunum and ileum and high risk of bowel perforation after traditional polypectomy. The modern enteroscopy is the only possible technique for visualizing and performing intraluminal endoscopic microsurgical manipulations in the deep sections of the small intestine. The study aims to develop an optimal method for the diagnosis and treatment of polyps in children with PJS.
Materials And Methods:
During 2015 to 2018 we conducted 30 comprehensive examinations of children with PJS in The Department of Endoscopic Research of the National Medical Research Center for Children's Health. We performed esophagogastroduodenoscopy and colonoscopy with removal of polyps more than 7 mm, then video capsule endoscopy and, guided by this, therapeutic single-balloon enteroscopy. Our technique for removal of polyps is general in all parts: (1) creating a "resistant pillow"; (2) electroexcision of polyp; (3) clipping the removal site.
Results:
Successfully performed electroexcision of polyps, which were located in the deep parts of the small intestine at a distance of 30 segments (one segment is 10 cm), reached a diameter of 2.5 cm, had a long pedicle. The postoperative period was uneventful.
Conclusion:
We have developed an optimal method of diagnostic and therapeutic measures, the observance of which allows us to avoid delayed perforations of the small intestine in the area of polypectomy in the postoperative period in children with PJS. Thanks to this technique, modern enteroscopy is becoming the only possible alternative to bowel resection in children with PJS.
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