Abstract
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.
Keywords
Peutz-Jeghers syndrome - endoscopy - enteroscopy - children
