Proposal of a Risk Scoring System to Facilitate the Treatment of Enteroenteric Intussusception in Peutz-Jeghers Syndrome

Abstract

Background/Aims: Enteroenteric intussusception in Peutz-Jeghers syndrome (EI-PJS) is traditionally treated by surgery. However, enteroscopic treatment is a minimally invasive approach worth attempting. We aimed to develop a risk scoring system to facilitate decision-making in the treatment of EI-PJS. Methods:This was a single-center case-control study, including 80 patients diagnosed with PJS and coexisting intussusception between January 2015 and January 2021 in Air Force Medical Center. We performed logistic regression analysis to identify independent risk factors and allocated different points to each subcategory of risk factors; the total score of individuals ranged from 0 to 9 points. Then, we constructed a risk stratification system based on the possibility of requiring surgery: 0-3 points for "low-risk," 4-6 points for "moderate-risk," and 7-9 points for "high-risk."Results: Sixty-one patients (76.25%) were successfully treated with enteroscopy. Sixteen patients (20.0%) failed enteroscopic treatment and subsequently underwent surgery, and three patients (3.75%) received surgery directly. Abdominal pain, the diameter of the responsible polyp, and the length of intussusception were independent risk factors for predicting the possibility of requiring surgery. According to the risk scoring system, the incidence rates of surgery were 4.44% in the low-risk tier, 30.43% in the moderate-risk tier, and 83.33% in the high-risk tier. From low-to high-risk tiers, the trend of increasing risk was significant (p<0.001). Conclusions:We developed a risk scoring system based on abdominal pain, diameter of the responsible polyps, and length of intussusception. It can preoperatively stratify patients according to the risk of requiring surgery for EI-PJS to facilitate treatment decision-making. (Gut Liver,

Discordance Rate and Risk Factor of Other Diagnostic Modalities for Small Bowel Tumors Detected by Device-Assisted Enteroscopy: A Korean Association for the Study of Intestinal Disease (KASID) Multicenter Study

“…15 Crosssectional imaging, DAE, and VCE are the most commonly used techniques for detecting small bowel tumors, and they have complementary advantages and disadvantages, and various optimal sequence of diagnostic techniques could be suggested. 16,17 Therefore, identifying the discrepancy of diagnostic modalities and finding associated factors is of great help in clinical practice. 18 Cross-sectional imaging, including CT and magnetic resonance imaging, could be recommended for the initial investigation of patients suspected of having small bowel tumors because it is noninvasive, as they can visualize the entire small intestine and surrounding structures.…”

“… 15 Cross-sectional imaging, DAE, and VCE are the most commonly used techniques for detecting small bowel tumors, and they have complementary advantages and disadvantages, and various optimal sequence of diagnostic techniques could be suggested. 16 , 17 Therefore, identifying the discrepancy of diagnostic modalities and finding associated factors is of great help in clinical practice. 18 …”