Retrospective Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2014; 6(7): 318-323
Published online Jul 16, 2014. doi: 10.4253/wjge.v6.i7.318
Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy
Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall’Oglio
Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall’Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
Author contributions: Torroni F and Rea F contributed to the manuscript writing and scientific revision; Romeo E and De Angelis P contributed to endoscopic treatment; Foschia F, Faraci S and Contini AC contributed to enrolling patients and data collecting; Caldaro T, Federici di Abriola G and Dall’Oglio L contributed to surgical treatment.
Supported by “Generazione e Sviluppo” Onlus, ASTALDI s.p.a. and Fondazione Charlemagne Onlus
Correspondence to: Filippo Torroni, MD, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy. ftorroni@gmail.com
Telephone: +39-66-8592841 Fax: +39-66-8592949
Received: January 21, 2014
Revised: March 18, 2014
Accepted: June 20, 2014
Published online: July 16, 2014
Processing time: 176 Days and 12.3 Hours
Abstract

AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in patients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps.

METHODS: Seven consecutive asymptomatic pts (age 15-38 years) with PJS have been collected; six underwent polypectomy using single balloon enteroscopy (Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit (OBCU Olympus Balloon Control Unit) and a disposable silicone splinting tube with balloon (ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endoscopy (WCE). Prophylactic polypectomy was reserved mainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from -6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure.

RESULTS: Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm (range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgical resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussusceptions. No gastrointestinal tumors were found in subsequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper endoscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps (> 15 mm).

CONCLUSION: The effective of prophylactic polypectomy of small bowel large polyps (> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.

Keywords: Peutz-Jeghers syndrome; Balloon assisted enteroscopy; Polypectomy

Core tip: Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by mucocutaneus pigmentation and multiple polyps in small bowel. Most of pts need surgical intervention for intussusceptions and gastrointestinal bleeding; the surgical risk is up to 50% in pts having a large polyps > 15 mm or rapidly growing. Enteroscopy balloon assisted with resection of small bowel large polyps is useful to avoid emergency laparotomy after performing wireless capsule endoscopy. The effective of prophylactic polypectomy of small bowel large polyps could be the first line treatment for conservative approach in management of PJS patients.