Ileoileal intussusception treated by polypectomy with spiral enteroscopy in Peutz–Jeghers syndrome

For two decades, deep enteroscopy using instruments such as double-balloon systems (Fujifilm, Tokyo, Japan) has enabled resection of small-bowel polyps in patients with Peutz–Jeghers syndrome [1]. However, these techniques are time consuming, which has been a major limitation. Motorized spiral enteroscopy (MSE; Olympus Medical, Tokyo, Japan) is a recent advancement in this field; however, very limited data on the efficacy of MSE are available [2] [3]. In a recent European prospective study in patients with suspected small-bowel disease, MSE showed a diagnostic yield of 74 %, a total enteroscopy rate of 10 %, and a low rate of major adverse events (1.5 %) [2].

We report the case of a 42-year-old woman with Peutz–Jeghers syndrome, referred to our center because of ileoileal intussusception confirmed by computed tomography (CT). She underwent retrograde enteroscopy with MSE.

The enteroscope was gently conducted through the intussusception by forward spiral progression, revealing a large 3-cm polyp at its upper limit. The lesion was resected in one peace with hot snare polypectomy following submucosal injection ([Video 1]); other similar polyps (0.5–3 cm), situated below the area, were also resected. The largest lesion underwent prophylactic clip closure of the defect using a hemostatic clip (Resolution 360; Boston Scientific, Marlborough, Massachusetts, USA ([Fig. 1]). The total procedure time was 60 minutes, including 30 minutes for resections. There were no reported major complications after the procedure, only minor bleeding without hemoglobin drop. CT performed 7 days after enteroscopy confirmed resolution of the intussusception ([Fig. 2]), and the patient reported no abdominal symptoms.

Video 1 Forward spiral progression through the intussusception followed by polypectomy of a large 3-cm polyp at the upper limit of the area.

Fig. 1 Computed tomography just after enteroscopy: ileoileal intussusception with hemostatic clip above the area (arrows).

Fig. 2 Computed tomography 7 days after enteroscopy: resolution of the intussusception. The clip can still be seen in the left lower quadrant (arrow).

This is the first description of an ileoileal intussusception caused by a large hamartomatous polyp being passed through using MSE, allowing polyp treatment and delayed resolution of the intussusception. MSE is thus an effective and promising diagnostic and therapeutic technology for small-bowel disease, requiring only standard endoscopy skills.

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• References

• 1 Gorospe EC, Alexander JA, Bruining DH. et al. Performance of double-balloon enteroscopy for the management of small bowel polyps in hamartomatous polyposis syndromes. J Gastroenterol Hepatol 2013; 28: 268-273
• 2 Beyna T, Arvanitakis M, Schneider M. et al. Motorised spiral enteroscopy: first prospective clinical feasibility study. Gut 2021; 70: 261-267
• 3 Ramchandani M, Rughwani H, Inavolu P. et al. Diagnostic yield and therapeutic impact of novel motorized spiral enteroscopy in small-bowel disorders: a single-center, real-world experience from a tertiary care hospital (with video). Gastrointest Endosc 2020;