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Risk factors analysis for small bowel polyp recurrence in children with Peutz-Jeghers syndrome: A retrospective
Shiqiu Xiong1,2, Huanyu Liu1,2, Shan Liu1,2
1Department of Gastroenterology, Xi'an Children's Hospital, Xi'an, China.
Insights
In Peutz-Jeghers syndrome (PJS) patients, having numerous large small bowel polyps increases recurrence risk. Early polyp screening is vital for managing this genetic disorder.
Area of Science:
- Pediatric Gastroenterology
- Clinical Genetics
- Oncology
Background:
- Peutz-Jeghers syndrome (PJS) is a hereditary disorder associated with gastrointestinal polyps, mucocutaneous pigmentation, and elevated cancer risk.
- Pediatric PJS patients frequently experience complications like intussusception, necessitating repeated surgical interventions.
Purpose of the Study:
- To identify clinical risk factors associated with the recurrence of small bowel polyps in pediatric patients diagnosed with PJS.
Main Methods:
- A retrospective analysis was conducted on 64 pediatric PJS patients with at least two follow-up visits.
- Data collected included demographics, clinical manifestations, and endoscopic findings. Recurrence was defined as polyps ≥15 mm.
- Kaplan-Meier curves and Cox proportional hazards models were employed to determine risk factors.
Main Results:
- The median age of the cohort was 8.0 years. The median time to polyp recurrence was 36.4 months.
- Recurrence rates at 12, 24, and 36 months were 19.8%, 33.2%, and 46.2%, respectively.
- A higher polyp count (≥10) and larger polyp diameter (≥2 cm) were significantly associated with increased recurrence risk (HR 5.61 and 1.20, respectively).
Conclusions:
- The number of small bowel polyps (≥10) and their diameter (≥2 cm) are independent predictors of recurrence in pediatric PJS.
- Routine and early endoscopic screening for polyps is crucial for managing PJS patients, even in the absence of symptoms.
Objectives:
Peutz-Jeghers syndrome (PJS) is a genetic disorder characterized by gastrointestinal polyps, mucocutaneous pigmentation, and increased malignancy risk. In pediatric patients, recurrent complications such as intussusception often result in frequent surgeries. This study aimed to identify clinical risk factors for small bowel polyp recurrence in children with PJS.
Methods:
We retrospectively analyzed 64 pediatric PJS patients who had at least two follow-up visits. Clinical data, including demographics, clinical features, and endoscopic findings, were collected. The primary outcome was recurrence of small bowel polyps, defined as polyps with a maximum diameter ≥ 15 mm. Kaplan-Meier survival curves and Cox proportional hazards models were used to assess risk factors.
Results:
The cohort's median age was 8.0 years, with a male-to-female ratio of 1.78:1. The median time to recurrence of small bowel polyps was 36.4 months. The estimated recurrence rates at 12, 24, and 36 months were 19.8% (95% confidence interval [CI]: 9.0%-29.3%), 33.2% (95%CI: 18.9%-44.9%), and 46.2% (95%CI: 28.0%-59.7%), respectively. Patients with a higher number of polyps (≥10) and larger polyp size (≥2 cm in diameter) exhibited a more rapid recurrence. Multivariate Cox regression analysis identified that the number of small bowel polyps (≥10) (hazard ratio [HR] 5.61, 95%CI: 1.65-19.09) and polyp size (HR 1.20, 95%CI: 1.01-1.42) were significantly associated with an increased risk of recurrence.
Conclusions:
Greater polyp number (≥10) and larger polyp diameter are independent risk factors for recurrence. Early screening for polyps is essential, even in asymptomatic PJS patients.
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