ENDOSCOPIC ISCHEMIC THERAPY FOR SMALL INTESTINAL POLYPS IN PATIENTS WITH PEUTZ-JEGHERS SYNDROME

Aims:

Most polyps in patients with Peutz-Jeghers syndrome (PJS) are pedunculated which is suited to snare polypectomy. To decrease the risk of bleeding or perforation, we perform selective ligation, so-called “ischemic therapy”, using a detachable snare or clip placed endoscopically. Some polyps do not auto-amputate with a single treatment and the efficacy of this technique is unknown. The aim of this study is to determine the efficacy and safety of ischemic therapy.

Methods:

The records of 61 consecutive patients with PJS who underwent double-balloon enteroscopy (DBE) at Jichi Medical University Hospital from July 2004 to August 2017 were reviewed. Of 61 patients, nine who underwent multiple sessions of ischemic therapy and no other treatment were included. The median follow-up was 40 months (range 17 – 76). Primary outcome measures include the mean number of polyps > 15 mm and maximum size of treated polyps in each session. Secondary outcomes included the need for laparotomy after the procedure and the incidence of adverse events.

Results:

The median number of sessions and DBEs per patient were 3 (2 – 5) and 6 (4 – 12, total 67), the median number of treated polyps per patient was 37 (5 – 164, total 359). The mean number of treated polyps larger than 15 mm per patient significantly decreased over time (first 6, second 2, third 1.5, forth 1, fifth 1.5, P = 0.01, R =-0.44, Spearman's rank correlation coefficient). The maximum size of polyps treated in each patient also significantly decreased (30 mm, 20 mm, 20 mm, 12.5 mm, 17.5 mm, P = 0.004, R =-0.49). No patient required laparotomy due to intussusception during the study period. No adverse events were observed in all 67 DBEs.

Conclusions:

Ischemic therapy for small intestinal polyps in patients with PJS is effective and safe, and avoids the needs for urgent laparotomy.