Endoscopic therapy of small-bowel polyps by double-balloon enteroscopy in patients with Peutz-Jeghers syndrome

Gao, Hong; van Lier, Margot G.; Poley, Jan Werner; Kuipers, Ernst J.; van Leerdam, Monique E.; Mensink, Peter B.

doi:10.1016/j.gie.2009.11.005

« Previous Next »Gastrointestinal Endoscopy
Volume 71, Issue 4 , Pages 768-773, April 2010

Endoscopic therapy of small-bowel polyps by double-balloon enteroscopy in patients with Peutz-Jeghers syndrome

Hong Gao, MD, PhD
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
Margot G. van Lier, MD
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
Jan Werner Poley, MD
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
Ernst J. Kuipers, MD, PhD
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
Monique E. van Leerdam, MD, PhD
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
Peter B. Mensink, MD, PhD
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Reprint requests: P.B.F. Mensink, MD, PhD, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

Received 21 August 2009; accepted 3 November 2009. published online 26 February 2010.

Background

Peutz-Jeghers syndrome (PJS) is a hereditary disorder characterized by mucocutaneous pigmentations and hamartomatous polyps mainly in the small bowel. These polyps may cause complications such as intussusception.

Objective

To assess therapeutic efficacy and safety of double-balloon enteroscopy (DBE) for detection and treatment of small-bowel polyps in patients with PJS.

Design

Prospective cohort study.

Setting

Tertiary-care referral center.

Patients

This study involved 13 patients with PJS, defined as a proven STK11 gene mutation or according to international diagnostic criteria.

Intervention

DBE with enteroscopic removal of pedunculated polyps of ≥10 mm.

Main Outcome Measurements

Location, number and size of small-bowel polyps, polypectomy data, and complications and long-term complications associated with development of small-intestine polyps.

Results

Thirteen patients with PJS (8 male, mean age 31 years) underwent 29 DBE procedures. Ten patients (77%) had a history of partial small-bowel resection because of small-bowel polyps. Small-bowel polyps were found in all 13 patients. The majority of polyps (94%) were located in the proximal jejunum. A total of 82 polyps of ≥10 mm were detected, and 79 (96%) were endoscopically removed without complications. After the introduction of DBE, no small-intestine-polyp-related complications occurred during a follow-up period of 356 person-months.

Limitations

Small number of patients.

Conclusion

DBE is clinically useful and safe for diagnosis and therapy of small-bowel polyps in patients with PJS, even in patients with a history of extensive abdominal surgery. DBE may decrease the need for laparotomy in patients with PJS.

Abbreviations: DBE, double-balloon enteroscopy, MR, magnetic resonance, PJS, Peutz-Jeghers syndrome, SBFT, small-bowel follow-through