Familial intestinal polyposis and device assisted enteroscopy: where do we stand?

Area of Science:

• Gastroenterology and Hereditary Cancer Syndromes

Background:

• Hereditary polyposis syndromes increase colorectal cancer risk.
• Familial adenomatous polyposis (FAP), Peutz-Jeghers (PJS), juvenile polyposis, Cowden, and Lynch syndromes are key examples.
• Small bowel polyps are a concern in some of these inherited conditions.

Purpose of the Study:

• To review the role of device-assisted enteroscopy (DAE) in managing small bowel polyps within hereditary polyposis syndromes.
• To outline current screening and therapeutic strategies for small bowel polyps in at-risk patient populations.

Main Methods:

• A narrative review of literature was conducted.
• PubMed database was searched in November 2022.
• Key findings were synthesized regarding diagnostic and therapeutic enteroscopy.

Main Results:

• Screening for small bowel polyps is specifically recommended for PJS, using MRI or VCE every 1-3 years.
• DAE is essential for therapeutic polypectomy, particularly for polyps causing symptoms or larger than a few millimeters.
• Both single (SBE) and double balloon enteroscopy (DBE) can resect polyps up to 10 cm, though American guidelines have restricted indications.

Conclusions:

• DAE plays a vital role in the management of small bowel polyps in specific hereditary polyposis syndromes.
• Only patients with PJS and FAP with significant small bowel polyp burden are likely to benefit from DAE.
• Current guidelines suggest targeted screening and therapeutic interventions for small bowel polyps in hereditary polyposis syndromes.