Nonsurgical management of small-bowel polyps in Peutz–Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy

BackgroundThe major problem in the management of Peutz–Jeghers syndrome (PJS) is small-bowel polyps, which can cause intussusception and bleeding. Double-balloon endoscopy (DBE) enables endoscopic resection of small-bowel polyps.ObjectiveThe aim of this study was to determine the efficacy and safety of endoscopic management of small-bowel polyps in PJS patients by using DBE.DesignRetrospective chart review.SettingSingle university hospital.PatientsConsecutive patients with PJS who underwent multiple sessions of DBE for evaluation or treatment of small-bowel polyps between September 2000 and April 2009.InterventionsEndoscopic resection of small-bowel polyps in PJS patients was performed by using DBE.Main Outcome MeasurementsEfficacy, safety, and long-term laparotomy rate after the procedures were evaluated.ResultsFifteen patients (10 men, mean age 34.0 ± 15.8 years) underwent DBE for a mean 3.0 ± 1.0 sessions. The mean numbers of resected polyps larger than 20 mm significantly decreased as sessions advanced (first, 3.6; second, 1.3; third, 0.7; fourth, 0.4; and fifth, 1.0; P = .02). The mean maximum sizes of resected polyps also significantly decreased at each session: 33, 19, 12, 17, and 30 mm (P = .01). One patient had a perforation, but was managed conservatively. Other complications were pancreatitis (n = 2) and bleeding (n = 2). Only 1 patient underwent surgery for intussusception during the study period.LimitationsThis was a small single-center retrospective study of short duration.ConclusionsEndoscopic management of small-bowel polyps in PJS patients by using DBE is safe and effective and avoids urgent laparotomy.