Small bowel polyp resection using device‐assisted enteroscopy in Peutz‐Jeghers Syndrome: Results of a specialised tertiary care centre

Abstract

Introduction Enteroscopy resection of small bowel polyps in Peutz-Jeghers syndrome has only been described in small case series. Herein, we aimed to assess the efficacy of enteroscopy resection of small bowel polyps within a specialised tertiary care centre and the impact on intraoperative enteroscopy. Methods This was an observational single-centre study. All adult Peutz-Jeghers syndrome patients followed in the Predisposition Digestive Ile-de-France network who underwent an endoscopic resection of at least one small bowel polyp ≥ 1 cm by enteroscopy between 2002–2015 were included. Small bowel polyps were detected under a dedicated screening programme by previous capsule endoscopy and/or magnetic resonance enterography, performed every 2–3 years. Complete treatment was defined as the absence of polyps ≥ 1 cm after conventional endoscopic resection. Intraoperative enteroscopy or surgical resection were indicated in incomplete treatments. The overall complete treatment rate including conventional enteroscopy and intraoperative enteroscopy was also considered. Results Endoscopic resection of 216 small bowel polyps (median: 8.6 per patient, size: 6–60 mm) was performed by 50 enteroscopies in 25 patients (mean age: 36 years, range: 18–71, 56% male) with small bowel polyp ≥ 1 cm. Twenty-three patients (92%) underwent 42 screening capsule endoscopies and 14 (57%) had 23 magnetic resonance enterographies during a median follow-up of 60 months. Complete treatment was achieved in 76%. Intraoperative enteroscopy and surgical resection were performed in four (16%) and two (8%) patients. Intraoperative enteroscopy improved by 16% the complete treatment rate and the overall rate was 92%. The complication rate was 6%. Conclusion This long-term study confirmed the efficacy and safety of endoscopic resection of small bowel polyps in Peutz-Jeghers syndrome. Intraoperative enteroscopy can be a complementary approach in selected cases.

A rare case of a juvenile polyp of patient with Peutz-Jeghers syndrome, complicated with intussusception of the small intestine

“…Other than intussusception, complications that can be observed in patients with PJS are hemorrhage, occlusion, gastrointestinal necrosis, perforation, and more in PJS individuals. [1] The majority of individuals with Peutz-Jeghers syndrome have been found to have germline mutation of the serine/threonine kinase-11 (LKB1/STK11) gene, located on chromosome 19p13.3. [2] Even though LKB1 mutation is claimed to be a tumor suppressor gene, nowadays, it is also considered as a tumorigenesis promoting gene.…”

“…It is characterized by the presence of hamartomatous polyps in the gastrointestinal tract, typically found in the small intestine and colon. [1] The PJS patients have an increased risk of malignancy compared with the general population. [2] Thus, they require a long-term follow-up to assess the diagnosis, treatment of malignant changes and other severe complications secondary to Peutz-Jeghers syndrome.…”

Safety and efficacy of an enteroscopy-based approach in reducing the polyp burden in patients with Peutz–Jeghers syndrome: experience from a tertiary referral center

“…11,14 However, although recent studies on the endoscopic management of PJS patients seem to provide consistent results, they include a limited number of patients, are often focused on the pediatric patients, and mostly have a short follow-up (Table 1). 8,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] In this study, we aimed to assess the impact of an enteroscopy-based approach (including both DAE and IOE) on the reduction of the polyp burden in a cohort of PJS patients. ).…”

Peutz-Jeghers syndrome in pediatric patients: experience in a tertiary care institution in Mexico

“…Among the histological findings, 12 of our patients presented hamartomatous polyps; however, the finding of inflammatory polyps, follicular hyperplasia, and adenomatous polyps was notable. Usually, hamartomatous polyps are benign; however, in PJS, they have the potential to develop gastrointestinal and extraintestinal neoplasms 35,36 . Some authors hypothesize that the malignant potential may be due to a genetic predisposition to mucosal prolapse that underlies the formation of polyps in this syndrome; however, no pathophysiological mechanism has been established to explain the propensity to cancer 33 .…”