Safety and efficacy of small bowel polypectomy using a balloon-assisted enteroscope in pediatric patients with Peutz-Jeghers syndrome

Blanco‐Velasco, Gerardo; Hernández-Mondragón, O.V.; Blancas-Valencia, Juan Manuel; Paz-Flores, V.; Fuentes-Hernández, D.; Rodríguez-González, Pablo; González-Ortiz, Beatriz

doi:10.1016/j.rgmxen.2018.03.010

Cited by 4 publications

(7 citation statements)

References 17 publications

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“…al examined 13 patients over 356 combined patient months to concluded that DBE is clinically useful and safe for diagnosis and therapy of small-bowel polyps in patients with PJS and it may decrease the need for laparotomy. [25] These results were replicated by Akarsu et al [32]. Kopacova et.…”

Section: Discussionmentioning

confidence: 65%

“…[8] The medical literature contains 19 previous studies describing experiences with DAE for endoscopic removal of small bowel hamartomas. [15,16,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] These articles vary significantly in regard to number of patients, geographic location, and observation period. Belsha et al followed a pediatric population in the USA of 16 patients demonstrated that DBE-facilitated polypectomy is an effective therapeutic option in pediatric patients with PJS over 26 months.…”

Section: Discussionmentioning

confidence: 99%

“…The medical literature contains 19 previous studies describing experiences with DAE for endoscopic removal of small-bowel hamartomas 15 16 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 . These articles vary significantly in regard to number of patients, geographic location, and observation period.…”

Section: Discussionmentioning

confidence: 99%

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Device-assisted enteroscopy in the surveillance of intestinal hamartomas in Peutz-Jeghers syndrome

Mohamed Elfeky,

Panjwani,

Cave

et al. 2023

Endosc Int Open

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Background: PJS is an autosomal dominant, genetic disorder characterized by the formation of hamartomatous polyps in the gastrointestinal tract. These polyps result in significant morbidity due to adverse events including intestinal obstruction, bleeding, and malignancy. The aim of this study was to describe the role of DAE in monitoring and prophylactic polypectomy within the small bowel. Methods: Electronic medical records were surveyed to identify all DAE procedures performed in patients with PJS within three U.S. referral centers between Jan 1st 2007 and January 1st 2020. Individual charts were reviewed to collect and analyze specific data points. Primary end points included adverse events associated with DAE-related polypectomy and the rate of laparotomy in PJS patients prior to, and following, index DAE. Secondary data points included patient characteristics, procedural details, and size/location/distribution of small bowel hamartomas. Results: 23 patients met our inclusion criteria. Of these, 18 (75%) previously undergone small bowel surgery prior to index DAE. Between 2007 – 2020, 46 DAE’s were performed in these patients with an average of one exam every 2.5 years. A total of 131 polypectomies were performed with an adverse event rate of 1.5%. None of our cohort required emergent surgery related to adverse events of small bowel hamartomas over 336 years of aggregated follow-up. Conclusions: Endoscopic management of small bowel polyps in patients with PJS using DAE is an effective strategy for prophylactic removal of hamartomas. DAE surveillance and endoscopic polypectomy is safe and may decrease the need for repeated laparotomy in patients with PJS.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Device-assisted enteroscopy in the surveillance of intestinal hamartomas in Peutz-Jeghers syndrome

Mohamed Elfeky,

Panjwani,

Cave

et al. 2023

Endosc Int Open

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“…The format of the study in this case does not imply a comparison of the results of the experimental and reference groups: to prove the effectiveness of the method, we cannot create a control group even from a small number of children and allow them to develop perforation: the perforation rate with open techniques is approximately 5%. 4,[16][17][18] The optimality and efficiency of the developed algorithm are determined by the presence of unique endoscopic equipment and the anatomical features of the localization of PJ polyps. Enteroscopy provides removal of polyps from the deep parts of the small intestine, it is an additional method for VCE.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] PJ polyps differ from adenomatous by the presence in the stroma of smooth muscle tufts emanating from the muscle plate of the mucous membrane, sowhen performing polypectomy there is a high risk of bowel perforation. 4 Historically, due to episodes of obstruction, approximately one-third of adults with PJS had a laparotomy by the age of 10. In addition, up to 70% of the patients with PJS under the age of 18 underwent at least one emergency laparotomy, and up to 40% of them underwent a second laparotomy for 5 years due to a complication associated with a polyp.…”

Section: Introductionmentioning

confidence: 99%

High-Tech Diagnostic Methods and Enteroscopic Treatment of Children with Peutz-Jeghers Syndrome

Kirakosyan

Лохматов

2019

Eur J Pediatr Surg

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Introduction Peutz-Jeghers syndrome (PJS) is an autosomal dominant hereditary hamartomatous polyposis with predominant localization in the jejunum and ileum and high risk of bowel perforation after traditional polypectomy. The modern enteroscopy is the only possible technique for visualizing and performing intraluminal endoscopic microsurgical manipulations in the deep sections of the small intestine. The study aims to develop an optimal method for the diagnosis and treatment of polyps in children with PJS. Materials and Methods During 2015 to 2018 we conducted 30 comprehensive examinations of children with PJS in The Department of Endoscopic Research of the National Medical Research Center for Children's Health. We performed esophagogastroduodenoscopy and colonoscopy with removal of polyps more than 7 mm, then video capsule endoscopy and, guided by this, therapeutic single-balloon enteroscopy. Our technique for removal of polyps is general in all parts: (1) creating a “resistant pillow”; (2) electroexcision of polyp; (3) clipping the removal site. Results Successfully performed electroexcision of polyps, which were located in the deep parts of the small intestine at a distance of 30 segments (one segment is 10 cm), reached a diameter of 2.5 cm, had a long pedicle. The postoperative period was uneventful. Conclusion We have developed an optimal method of diagnostic and therapeutic measures, the observance of which allows us to avoid delayed perforations of the small intestine in the area of polypectomy in the postoperative period in children with PJS. Thanks to this technique, modern enteroscopy is becoming the only possible alternative to bowel resection in children with PJS.

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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

Valdivia¹,

Rondonotti

Pennazio

2020

Clin Med Insights Gastroenterol

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Background: Patients with Peutz–Jeghers syndrome develop hamartomatous polyps in the small bowel, possibly causing anemia, intussusception, and obstruction. We aimed to evaluate the impact of an enteroscopy-based approach, including both device-assisted and intraoperative enteroscopy, on the reduction of the polyp burden in a cohort of adult Peutz–Jeghers syndrome patients. Materials and methods: A retrospective study was conducted at Azienda Ospedaliero-Universitaria Città della Salute e della Scienza in Turin, Italy. Consecutive Peutz–Jeghers syndrome patients eligible for device-assisted or intraoperative enteroscopy, between January 2003 and November 2019, were included. Enteroscopy technical issues and complications were recorded. At the time of index enteroscopy, the patients’ clinical records were retrospectively reviewed, and clinical data were recorded until November 2019. Results: Overall, 24 patients were included. Before inclusion, 16/24 patients (66.7%) underwent small bowel surgery for polyp-related complications, 13 of which (81.2%) in an emergent setting. Two patients had a history of small bowel neoplasms. During the timeframe, 47 device-assisted enteroscopies and 9 intraoperative enteroscopies were performed, and 247 small bowel polyps were endoscopically removed. The overall complication rate was 12.8% (8.5% for device-assisted enteroscopy, 22.2% for intraoperative enteroscopy). The median observation time was 108 months: in this timeframe, two patients developed small bowel polyp-related complications requiring emergent surgery. No patients developed small bowel cancer, but nine extra-gastrointestinal neoplasms were recorded. Conclusion: An enteroscopy-based approach appears to be well tolerated and effective in decreasing polyp-related complications in Peutz–Jeghers syndrome patients, thus reducing the need for emergent surgery. Although the prevention of small bowel polyp-related complications remains the main goal in these patients, the high incidence of extra-gastrointestinal neoplasms appears to be a rising issue.

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Safety and efficacy of small bowel polypectomy using a balloon-assisted enteroscope in pediatric patients with Peutz-Jeghers syndrome

Cited by 4 publications

References 17 publications

Device-assisted enteroscopy in the surveillance of intestinal hamartomas in Peutz-Jeghers syndrome

Device-assisted enteroscopy in the surveillance of intestinal hamartomas in Peutz-Jeghers syndrome

High-Tech Diagnostic Methods and Enteroscopic Treatment of Children with 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

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