Original articleClinical endoscopyNonsurgical management of small-bowel polyps in Peutz–Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy
Section snippets
Patients and methods
We prospectively entered the medical history and endoscopic and clinical findings into a database of all patients who had undergone DBE at Jichi Medical University Hospital. The database was registered with approval of the University. From this database, patients with PJS who underwent multiple sessions of DBE for evaluation or treatment of small-bowel polyps were selected. We defined 1 session as hospitalization for DBE in which more than 1 procedure could be performed. Fifteen patients (88
Patient characteristics
Fifteen patients were included in this study from September 2000 to April 2009. A total of 88 DBEs were performed in these patients during this period. The mean number of DBEs per patient was 5.9 ± 2.0 (range 3–10), and the mean number of sessions per patient was 3.0 ± 1.0 (range 2–5). Endoscopic resection of small-bowel polyps was performed in 71 DBE procedures (80.7% of procedures) (Table 1).
Number and size of resected polyps
A total of 341 small-bowel polyps were resected. The mean number of resected polyps per patient was
Discussion
This study showed that our strategy of endoscopic management of small-bowel polyps in PJS patients was useful for reducing polyp size, preventing intussusceptions, and avoiding laparotomy. We presume that the number of polyps could be reduced by using our strategy, with eventual elimination of significant polyps in PJS patients.
Small-bowel polyps are the most significant clinical feature of PJS. These hamartomas can lead to significant complications such as bowel obstruction and severe GI
References (23)
- et al.
Peutz-Jeghers syndrome: 78-year follow-up of the original family
Lancet
(1999) - et al.
Small bowel polyps in Peutz-Jeghers syndrome: management by combined push enteroscopy and intraoperative enteroscopy
Gastrointest Endosc
(2000) - et al.
Total enteroscopy with a nonsurgical steerable double-balloon method
Gastrointest Endosc
(2001) - et al.
Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy
Gastrointest Endosc
(2005) - et al.
Laparoscopic-assisted double-balloon enteroscopy for small-bowel polyp surveillance and treatment in patients with Peutz-Jeghers syndrome
Gastrointest Endosc
(2006) - et al.
Endoscopic therapy of small-bowel polyps by double-balloon enteroscopy in patients with Peutz-Jeghers syndrome
Gastrointest Endosc
(2010) - et al.
Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases
Clin Gastroenterol Hepatol
(2004) - et al.
A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary GI polyposis syndromes
Gastrointest Endosc
(2005) - et al.
Comparison of detectability of small-bowel lesions between capsule endoscopy and double-balloon endoscopy for patients with suspected small-bowel disease
Gastrointest Endosc
(2009) - et al.
Significant small-bowel lesions detected by alternative diagnostic modalities after negative capsule endoscopy
Gastrointest Endosc
(2008)
Generalized intestinal polyposis and melanin spots of the oral mucosa, lips and digits; a syndrome of diagnostic significance
N Engl J Med
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DISCLOSURE: The following author disclosed financial relationships relevant to this publication: Dr. Yamamoto has applied for a patent in Japan for the double-balloon system described in this article; he is a consultant to and has ownership interest in Fujifilm. The other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 374.