Recurrent small intestine intussusception in a patient with Peutz-Jeghers syndrome

Ioannidis, Orestis; Papaemmanouil, Styliani; Paraskevas, George; Kotronis, Anastasios; Chatzopoulos, Stavros; Konstantara, Athina; Papadimitriou, Nikolaos; Makrantonakis, Apostolos; Kakoutis, Emmanouil

doi:10.4321/s1130-01082012000100009

Cited by 4 publications

(4 citation statements)

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“…The majority of patients with PJS had a history of small bowel surgery. The risk of intussusception and intestinal obstruction before the age of 20 years is up to 50% in particular in patients having a large polyps > 15 mm or rapidly growing [6][7][8] .…”

Section: Discussionmentioning

confidence: 99%

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy

Torroni

Romeo

Rea

et al. 2014

WJGE

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AIM:To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in patients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS:Seven consecutive asymptomatic pts (age 15-38 years) with PJS have been collected; six underwent polypectomy using single balloon enteroscopy (Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit (OBCU Olympus Balloon Control Unit) and a disposable silicone splinting tube with balloon (ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endoscopy (WCE). Prophylactic polypectomy was reserved mainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from -6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure. RESULTS:Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm (range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgical resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussusceptions. No gastrointestinal tumors were found in subsequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper endoscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps (> 15 mm). CONCLUSION:The effective of prophylactic polypectomy of small bowel large polyps (> 15 mm) could be the first line treatment for conservative approach in management of PJS patients. small bowel large polyps is useful to avoid emergency laparotomy after performing wireless capsule endoscopy. The effective of prophylactic polypectomy of small bowel large polyps could be the first line treatment for conservative approach in management of PJS patients.

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Section: Discussionmentioning

confidence: 99%

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy

Torroni

Romeo

Rea

et al. 2014

WJGE

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“…Although hamartomatous polyps can arise within the whole GI tract, small bowel is the most common site . The risks of intussusceptions, GI hemorrhage and small bowel obstruction significantly increase in patients with PJS …”

Section: Introductionmentioning

confidence: 99%

“…3 The risks of intussusceptions, GI hemorrhage and small bowel obstruction significantly increase in patients with PJS. 4,5 Double-balloon enteroscopy (DBE) has been widely used as a reliable tool for the diagnosis and treatment of polyps. 6 Consequently, a polypectomy using DBE might reduce the occurrence of PJS-related *These authors contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

The role of double‐balloon enteroscopy in reducing the maximum size of polyps in patients with Peutz‐Jeghers syndrome: 12‐year experience

Wang

Bian

Zhu

et al. 2019

J of Digest Diseases

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Objective This study aimed to evaluate the role of double‐balloon enteroscopy (DBE) in treating intestinal polyps in patients with Peutz‐Jeghers syndrome (PJS). Methods All patients diagnosed with PJS who underwent a polypectomy under DBE from October 2006 to December 2018 were enrolled. Their clinical records, including surgical history, the method of DBE insertion, the number of DBE procedures, and the maximum size and number of the resected polyps, were retrospectively reviewed. Results Altogether 97 patients were enrolled. For both antegrade and retrograde DBE the maximum size of the resected polyps during the second hospitalization was significantly smaller than that during the first hospitalization (antegrade DBE: [2.13 ± 1.51] cm vs [3.63 ± 0.92] cm, P = 0.012; retrograde DBE: [1.20 ± 1.10] cm vs [2.95 ± 1.95] cm, P = 0.03), but was significantly larger than that during the third hospitalization (antegrade DBE: [2.13 ± 1.51] cm vs [0.88 ± 0.70] cm, P = 0.012; retrograde DBE: [1.20 ± 1.10] cm vs [0.46 ± 0.40] cm, P = 0.048). The interval between the second and third hospitalizations was significantly longer than that between the first and second hospitalizations ([899.00 ± 382.12] days vs [537.27 ± 326.28] days, P = 0.027). The success rate of total enteroscopy was 58.3% (28/48), which was not affected by a history of laparotomy (61.5% vs 52.4%, P = 0.528). The complication rate was 4.4%. Conclusion DBE is clinically safe and effective for the diagnosis and treatment of intestinal polyps in patients with PJS.

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“…Peutz‐Jeghers polyps can occur anywhere in the gastrointestinal tract, but are most commonly located in the jejunum and ileum 2 . Most patients with PJS polyps present with discomfort, including stomachache and diarrhea, and are at high risks of gastrointestinal bleeding, intussusception, 3 and intestinal obstruction 4 . A previous study has confirmed that the cumulative risk of cancer increases sharply to 30.9% in patients older than 40 years 5 …”

Section: Introductionmentioning

confidence: 99%

Alterations and clinical relevance of gut microbiota in patients with Peutz–Jeghers syndrome: A prospective study

Wang

Huabing

Yan

et al. 2023

J of Digest Diseases

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Objective In this case–control study we aimed to investigate the intestinal microbiota profile of patients with Peutz‐Jeghers syndrome (PJS) and its association with polyp growth. Methods Thirty‐two PJS patients and 35 healthy controls were enrolled. Fecal samples of all participants were collected for gut microbiota analysis via 16S rRNA gene (regions V3–V4) sequencing. SPSS version 22.0 and R software version 3.1.0 were used for the statistical analysis. Results The richness was comparable, while the overall structure of the gut microbiota differed significantly between the PJS and control groups (weighted UniFrac, P = 0.001; unweighted UniFrac, P = 0.008). Significantly different abundances of two phyla, seven families, and 18 genera as well as twenty‐nine differentially enriched functional modules (false discovery rate, P < 0.05) between the two groups were identified. Morganella was positively associated with the median number of polyps (JPN; r = 0.96, P < 0.001) and number of newly discovered polyps in the jejunum between two recent endoscopic resections (JPNG; r = 0.78, P = 0.04). Desulfovibrio was positively associated with JPNG (r = 0.87, P = 0.01). Blautia was negatively associated with the median maximum size of polyps in the jejunum (JPS). Anaerostipes was negatively associated with JPN, JPNG and JPS. Clostridium XVIII and Fusicatenibacter were negatively associated with JPN and JPS, respectively. Conclusions We found remarkably different gut microbiota of patients with PJS compared to healthy individuals and associations between specific fecal bacteria and clinical features of PJS. These findings may provide a new perspective for the management of PJS in clinical practice.

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Recurrent small intestine intussusception in a patient with Peutz-Jeghers syndrome

Cited by 4 publications

References 5 publications

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy

The role of double‐balloon enteroscopy in reducing the maximum size of polyps in patients with Peutz‐Jeghers syndrome: 12‐year experience

Alterations and clinical relevance of gut microbiota in patients with Peutz–Jeghers syndrome: A prospective study

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