Tactics of surgical treatment of children with small intestinal polyps with Peutz–Jeghers syndrome and juvenile polyposis

Abstract

Background. Polyps of the small intestine in Peutz–Jeghers syndrome and juvenile polyposis can cause obstruction of the gastrointestinal tract, and with age they can cause the development of cancer. Currently, there is no consensus on diagnostic methods and treatment tactics for polyps in the deep parts of the small intestine in children, since both diseases are rare and there are not many works devoted to this problem in the literature. Aim. To analyze 13 years of experience in treating patients and formulate treatment tactics for children with hamartomatous polyps of the small intestine with Peutz–Jeghers syndrome and juvenile polyposis. Materials and methods. In the period from 2012 to 2024, on the basis of the department of general and planned surgery of the National Medical Research Center for Children's Health, 44 children were treated – 35 (80.4%) patients diagnosed with Peutz–Jeghers syndrome and 9 (19.6%) diagnosed with juvenile polyposis, – who were hospitalized 81 times. All patients underwent abdominal ultrasound upon admission. Sixteen patients underwent video capsule enteroscopy (VCE), and 82 diagnostic and therapeutic balloon enteroscopy (BE) were performed – 74 (90.2%) antegrade BE and 8 (9.75%) retrograde. Results. According to ultrasound of the abdominal organs, only 25 (30.8%) cases revealed pathological changes in the abdominal cavity. Ultrasound testing showed a specificity of 78% and sensitivity of 36%. However, ultrasound allows one to assess intramural blood flow and determine further treatment tactics. VBE demonstrates a sensitivity of 97.4% and a specificity of 85.5%, which makes it possible to reliably assess the prevalence and localization of the process. BE also showed high sensitivity of 92.1% and specificity of 82% as a diagnostic method, and also showed high efficiency and safety as a method of minimally invasive intraluminal treatment. Conclusion. Diagnosis of small intestinal polyps requires a consistent and multidisciplinary approach. Evaluation of ultrasound and VCE data allows one to determine indications for intraluminal (antegrade/retrograde) or surgical treatment.