Subscribe to RSS
DOI: 10.1055/a-2180-9442
Repeat bidirectional double-balloon enteroscopy 1 year later may be proper in Peutz-Jeghers patients with difficult-to-reach polyps
Abstract
Background and study aims Small-bowel polyps in patients with Peutz–Jeghers syndrome (PJS) are sometimes difficult to reach using double-balloon enteroscopy (DBE). However, they can induce intussusception, especially when ≧15 mm. This study aimed to review the outcomes of patients with such polyps.
Patients and methods All patients with PJS with small-bowel polyps that bidirectional DBE failed to reach and were ≧5 mm as shown by DBE enterography at our institution from May 2006 to April 2022 were retrospectively evaluated. The endpoint was the earliest occurrence of symptomatic intussusception induced by the polyp, endoscopic removal by repeat DBE or intraoperative endoscopy, or the last medical record describing the patient’s condition.
Results This study included 27 polyps in 13 patients. All patients had extraluminal adhesions. None developed symptomatic intussusception, eight patients underwent endoscopic removal at repeat DBE without surgery, two patients underwent removal with intraoperative endoscopy, two patients were observed without polyp removal, and one patient had a polyp removed at repeat DBE and three unreachable polyps remained. Repeat DBE without surgery was able to remove 14 polyps (52%). Polyps ≧15 mm included 11 lesions in eight patients and were observed for a median of 14 months without symptomatic intussusception.
Conclusions The difficult-to-reach polyps may have a low risk of immediate symptomatic intussusception, possibly due to limited bowel mobility by extraluminal adhesions, and the likelihood of reaching them at repeat DBE was substantial. Hence, repeat DBE 1 year later may be proper in such patients with PJS.
Publication History
Received: 26 April 2023
Accepted after revision: 01 September 2023
Accepted Manuscript online:
25 September 2023
Article published online:
12 December 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Jeghers H, Mc KV, Katz KH. Generalized intestinal polyposis and melanin spots of the oral mucosa, lips and digits; a syndrome of diagnostic significance. N Engl J Med 1949; 241: 1031-1036 DOI: 10.1056/NEJM194912292412601. (PMID: 15398245)
- 2 Boland CR, Idos GE, Durno C. et al. Diagnosis and management of cancer risk in the gastrointestinal hamartomatous polyposis syndromes: Recommendations from the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2022; 117: 846-864
- 3 Wagner A, Aretz S, Auranen A. et al. The management of Peutz-Jeghers Syndrome: European Hereditary Tumour Group (EHTG) guideline. J Clin Med 2021; 10: 473 DOI: 10.3390/jcm10030473. (PMID: 33513864)
- 4 van Lier MG, Mathus-Vliegen EM, Wagner A. et al. High cumulative risk of intussusception in patients with Peutz-Jeghers syndrome: time to update surveillance guidelines?. Am J Gastroenterol 2011; 106: 940-945
- 5 Sakamoto H, Yamamoto H, Hayashi Y. et al. Nonsurgical management of small-bowel polyps in Peutz-Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy. Gastrointest Endosc 2011; 74: 328-333
- 6 Khurelbaatar T, Sakamoto H, Yano T. et al. Endoscopic ischemic polypectomy for small-bowel polyps in patients with Peutz-Jeghers syndrome. Endoscopy 2021; 53: 744-748
- 7 Ono Y, Oguro K, Yano T. et al. Ischemic polypectomy using a diagnostic-type double-balloon endoscope with a modified detachable snare. Endoscopy 2023; 55: E294-E296
- 8 Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013; 48: 452-458 DOI: 10.1038/bmt.2012.244. (PMID: 23208313)
- 9 Murino A, Nakamura M, Despott EJ. et al. Factors associated with reduced insertion depth at double balloon enteroscopy: a retrospective, multivariate analysis. Dig Liver Dis 2014; 46: 956-958
- 10 Domagk D, Bretthauer M, Lenz P. et al. Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial. Endoscopy 2007; 39: 1064-1067 DOI: 10.1055/s-2007-966990. (PMID: 18072057)
- 11 Liu S, Dong T, Shi Y. et al. Water exchange-assisted versus carbon dioxide-insufflated single-balloon enteroscopy: a randomized controlled trial. Endoscopy 2022; 54: 281-289 DOI: 10.1055/a-1459-4571. (PMID: 33754332)
- 12 Limpias Kamiya KJL, Hosoe N, Takabayashi K. et al. Feasibility and safety of endoscopic ischemic polypectomy and clinical outcomes in patients with Peutz-Jeghers syndrome (with video). Dig Dis Sci 2023; 68: 252-258
- 13 Giardiello FM, Brensinger JD, Tersmette AC. et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology 2000; 119: 1447-1453
- 14 Wang J, Guo Q, Zhao J. et al. Multidetector CT enterography versus double-balloon enteroscopy: comparison of the diagnostic value for patients with suspected small bowel diseases. Gastroenterol Res Pract 2016; 2016: 5172873
- 15 Gupta A, Postgate AJ, Burling D. et al. A prospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jeghers syndrome. AJR Am J Roentgenol 2010; 195: 108-116
- 16 Ohmiya N, Nakamura M, Takenaka H. et al. Management of small-bowel polyps in Peutz-Jeghers syndrome by using enteroclysis, double-balloon enteroscopy, and videocapsule endoscopy. Gastrointest Endosc 2010; 72: 1209-1216 DOI: 10.1016/j.gie.2010.08.018. (PMID: 20970791)