Nonsurgical management of small-bowel polyps in Peutz–Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy

Double-balloon enteroscopy in the management of patients with Peutz-Jeghers syndrome: a retrospective cohort multicenter study

“…Despite the high therapeutic performance reported in the study, six patients were still referred for elective primary or adjuvant surgical resection (2 with IOE) due to the presence of large polyps that could not be safely removed endoscopically. Our high surgical referral rate in comparison with results previously reported (15,16), in which only one out of 28 patients was referred for elective laparotomy, outlines some limitations of DBE when dealing with polyps that are bulky, locally concentrated in large numbers, invaginated and thick-stalked, and those with serosal retraction into the stalk. Mathus-Vliegen and Tytgat (22) had already noted, back in 1986 when performing IOE, that under these circumstances polyps were unsuitable for polypectomy even if performed during surgery, and recommended that such lesions be removed by enterectomy.…”

“…Two studies have reported that the total enteroscopy rate and maximum insertion depth at DBE was significantly lower in patients with PJS and a history of laparotomies than in those without previous laparotomies (16,17). In the present study, total enteroscopy was achieved in only one patient, but this fact did not hampered therapeutic performance or resulted in a complicated disease course.…”

“…In two patients, multiple polyps (10-60 mm) were detected in the jejunum and ileum and resected without subsequent bleeding or perforation. Since then, a few studies have reported the clinical applicability of DBE in PJS patients (15)(16)(17)(18).…”

“…Unlike two former studies (15,16), where DBE was used as a diagnostic and therapeutic tool, the centers participating in this study favor a step-up approach for surveillance, making complementary use of the different techniques. As a first step we use VCE because it is a safe, non-invasive and sensitive method for visualization of the small-bowel lumen and the detection of polyps.…”

“…Until a couple of years ago, little was known about the clinical impact of surveillance and treatment of small-bowel polyps by using DBE in PJS patients (14). Since then, some studies have described a high diagnostic yield of DBE in PJS patients with successful polypectomy which, in theory, might prevent intussusceptions and avoid the need for emergency surgery (15)(16)(17)(18).…”