Radical Endoscopic Polypectomy Combined With Double‐balloon Enteroscopy and Colonoscopy for Peutz‐Jeghers Syndrome

Hsu, Tzu-Chien; Lee, Tsung-Chun; Chiu, Han–Mo; Wu, Jia‐Feng; Yen, Tsorng-Jou; Hsiao, Tsung-Hsien; Jeng, Yung‐Ming; Ni, Yen‐Hsuan

doi:10.1097/mpg.0b013e3181de836d

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…Evaluation for and management of small bowel polyps continue to evolve. New nonradiating imaging techniques such as video capsule endoscopy (24), magnetic resonance enterography (25), and new interventional techniques such as single‐ and double‐balloon enteroscopy (26) show promise for the prevention of morbidity, but are still unproven.…”

Section: Discussionmentioning

confidence: 99%

Peutz‐Jegher Syndrome in Childhood

Goldstein¹,

Hoffenberg²

2013

J. pediatr. gastroenterol. nutr.

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Section: Discussionmentioning

confidence: 99%

Peutz‐Jegher Syndrome in Childhood

Goldstein¹,

Hoffenberg²

2013

J. pediatr. gastroenterol. nutr.

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“…Endoscopic polypectomy has distinct advantages of being non-surgical and offering removal of synchronous polyps in one procedure. Single and double balloon enteroscopy and spiral enteroscopy are endoscopic technologies that allow deeper penetration into the small intestine but can be limited by individual anatomical variations, operator skill, and availability [1,2]. Repeated surgeries of the abdomen are sometimes required and can lead to intra-abdominal scar tissue (adhesions) that makes successive surgery more difficult to perform.…”

Section: Introductionmentioning

confidence: 99%

A rationale for mTOR inhibitors as chemoprevention agents in Peutz-Jeghers syndrome

Kuwada

Burt

2011

Familial Cancer

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Peutz-Jeghers patients frequently develop clinically significant complications, namely hemorrhage and bowel obstruction, from small intestinal hamartomatous polyps that frequently require surgery. In addition, many PJS patients develop epithelial malignancies in a variety of organs. The vast majority of PJS is due to germline alterations in the STK11 gene that encodes a protein that modulates PI3-kinase signaling, a key regulator of cell survival and growth. One of the major downstream mediators of PI3-kinase signaling is mTOR, the mammalian target of rapamycin. Several drugs that inhibit the PI3-kinase signal transduction pathway are in development and one, RAD001 (everolimus), an mTOR inhibitor, was recently approved for the treatment of renal cell carcinoma. Effective chemoprevention of intestinal polyps would be a first step in simplifying and improving the management of PJS patients. We present here, the rationale for the first human PJS chemoprevention trial using an mTOR inhibitor.

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confidence: 99%

“…DBE and SBE are two currently available techniques for diagnostic and therapeutic small bowel enteroscopy. Multiple studies have been published regarding successful use of DBE [Hsu et al 2010;Chen et al 2011;Sakamoto et al 2011]; however, only very limited data is available regarding the use of SBE for prophylactic radical polypectomy from the small bowel in PJS patients. Since both balloons in DBE are made of latex, we were obligated to use SBE since our patient had severe latex allergy.…”

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confidence: 99%

Single-balloon enteroscopy in managing Peutz Jeghers syndrome polyps

Aggarwal

Kumaravel

Upchurch

2012

Therap Adv Gastroenterol

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Peutz Jeghers syndrome (PJS) is an autosomal dominant condition characterized by hamartomatous polyps throughout the gastrointestinal (GI) tract and mucosal cutaneous pigmentation [Beggs et al. 2010]. PJS is associated with increased risk of GI and non-GI malignancies, the most common site being colorectal followed by breast, stomach, small bowel and pancreas. These hamartomatous polyps can be present anywhere in the GI tract. Most of these polyps become symptomatic at an early age requiring emergent laparotomies and bowel resections. Published guidelines have suggested frequent surveillance starting at an early age and endoscopic removal of polyps intraoperatively [Beggs et al. 2010]. Lately double-balloon enteroscopy (DBE) alone has been used for excision of these polyps [Gao et al. 2010]. Since the overtube and enteroscope balloons are made of latex, the procedure is not suitable for patients with severe latex allergy. In our institution, we recently used single-balloon enteroscopy (SBE) (Figure 1) for radical polypectomy in a patient with PJS and latex allergy highlighting the feasibility and safety of the procedure.A 33-year-old female patient with a history of PJS presented for deep enteroscopy to evaluate for small bowel polyps. She complained of intermittent mid-abdominal pain. Small bowel follow through and capsule endoscopy showed significant polyp burden with size ranging from 5 mm to 3 cm primarily in the proximal and mid jejunum. Thrice in the past she had resections of her small bowel for polyps; on one occasion this was an emergency procedure due to obstruction. This time the patient had severe reservations against surgery. She also had a history of severe latex allergy with anaphylaxis and therefore we wanted to avoid DBE. We performed a series of four SBEs over a period of 1 year. Most of the large polyps >1 cm were removed (Figure 2). Some small polyps were also removed to clear the lumen and visibility. All procedures lasted between 89 and 124 minutes and were done under monitored anesthesia care (MAC) without needing any intubation. Roth nets were used to retrieve polyps. The enteroscope was inserted to a greater depth with each procedure and a depth of 300 cm from the ligament of Treitz was achieved during the last procedure. Capsule and CT enterography were performed intermittently to reassess polyp burden. We encountered one complication of bleeding after polypectomy that was managed conservatively. Histopathology of her polyps was confirmed to be hamartomatous with no adenomatous or malignant polyps.SBE is a novel technique of enteroscopy. The enteroscope currently available, Olympus SIF-Q180 ® , uses one balloon to pleat the small bowel over the overtube while the tip of the endoscope is

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Radical Endoscopic Polypectomy Combined With Double‐balloon Enteroscopy and Colonoscopy for Peutz‐Jeghers Syndrome

Cited by 3 publications

References 11 publications

Peutz‐Jegher Syndrome in Childhood

Peutz‐Jegher Syndrome in Childhood

A rationale for mTOR inhibitors as chemoprevention agents in Peutz-Jeghers syndrome

Single-balloon enteroscopy in managing Peutz Jeghers syndrome polyps

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