Ischemic polypectomy for small-bowel polyps in pediatric Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is characterized by the development of hamartomatous polyps in the gastrointestinal tract that can cause chronic blood loss. Ischemic polypectomy has emerged as a low-risk technique in adult patients with PJS but remains largely undocumented in pediatric populations. This video presents the first published case demonstrating ischemic polypectomy in a pediatric patient, to our knowledge.

A 12-year-old girl with PJS and chronic anemia underwent balloon-assisted enteroscopy. Seven pedunculated small-bowel polyps were identified and treated using ischemic polypectomy with a detachable snare.

Three representative polypectomies are shown. The snare was tightened at the polyp stalk until ischemic changes occurred, then cinched and deployed. One instance required a second snare because of equipment malfunction. All polyps were successfully treated without electrocautery, bleeding, or perforation. Follow-up demonstrated improvement in longstanding anemia, with a rise in hemoglobin from 9.1 to 12.4 g/dL at 6 weeks, supporting therapeutic benefit. Repeat capsule endoscopy was planned.

Ischemic polypectomy using balloon-assisted enteroscopy is feasible, effective, and safe in pediatric PJS. By avoiding thermal energy, it may reduce the risk of transmural injury and represents a valuable option for children with numerous pedunculated small-bowel polyps.