Updates in the diagnosis and management of non-ampullary small-bowel polyposis

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Hereditary Gastrointestinal Polyposis Syndromes

Background:

• Advances in endoscopic technology have transformed the diagnosis and management of non-ampullary small-bowel polyposis.
• Hereditary polyposis syndromes, including Peutz-Jeghers syndrome (PJS), familial adenomatous polyposis (FAP), and juvenile polyposis syndrome (JPS), present unique challenges in small bowel surveillance and management.

Purpose of the Study:

• To provide an updated overview of the diagnostic and management strategies for non-ampullary small-bowel polyposis, focusing on hereditary polyposis syndromes.
• To highlight current recommendations for endoscopic surveillance intervals and polyp resection thresholds based on syndrome type and polyp size.

Main Methods:

• Review of current literature and guidelines regarding endoscopic surveillance and management of small bowel polyps in PJS, FAP, and JPS.
• Discussion of emerging endoscopic techniques such as ischemic polypectomy and endoscopic reduction of intussusception.

Main Results:

• For PJS, capsule endoscopy surveillance should begin by age eight, with polyps >15 mm requiring treatment to prevent intussusception.
• For FAP, initial screening of the proximal jejunum is recommended around age 25, with individualized duodenal surveillance intervals; resection of adenomas >1 cm is advised.
• Small bowel involvement in JPS is infrequent and primarily duodenal, without indication for distal small bowel investigation.

Conclusions:

• Tailored endoscopic surveillance and timely intervention are crucial for managing small bowel polyposis in hereditary syndromes.
• Emerging endoscopic techniques offer promising alternatives for polyp management and complication prevention.
• Adherence to syndrome-specific guidelines and consideration of polyp characteristics are essential for optimal patient outcomes.