Device-assisted enteroscopy in the surveillance of intestinal hamartomas in Peutz-Jeghers syndrome

Omar Wahid Mohamed Elfeky; Suraj Panjwani; David Cave; Daniel Wild; Daniel Raines

doi:10.1055/a-2197-8554

Device-assisted enteroscopy in the surveillance of intestinal hamartomas in Peutz-Jeghers syndrome

Endosc Int Open. 2024 Jan 30;12(1):E128-E134. doi: 10.1055/a-2197-8554. eCollection 2024 Jan.

Authors

Omar Wahid Mohamed Elfeky¹, Suraj Panjwani², David Cave², Daniel Wild³, Daniel Raines⁴

Affiliations

¹ Internal Medicine, LSU Health New Orleans, New Orleans, United States.
² Gastroenterology, University of Massachusetts Chan Medical School Department of Medicine, Worcester, United States.
³ Gastroenterology, Duke University Medical Center, Durham, United States.
⁴ Gastroenterology, LSU Health New Orleans, New Orleans, United States.

Abstract

Background and study aims Peutz-Jeghers syndrome (PJS) is an autosomal-dominant genetic disorder characterized by the formation of hamartomatous polyps in the gastrointestinal tract. These polyps result in significant morbidity due to adverse events (AEs) including intestinal obstruction, bleeding, and malignancy. The aim of this study was to describe the role of device-assisted enteroscopy (DAE) in monitoring and prophylactic polypectomy within the small bowel. Patients and methods Electronic medical records were surveyed to identify all DAE procedures performed in patients with PJS at three US referral centers between January 1, 2007 and January 1, 2020. Individual charts were reviewed to collect and analyze specific data points. Primary end points included AEs associated with DAE-related polypectomy and the rate of laparotomy in PJS patients prior to, and following, index DAE. Secondary data points included patient characteristics, procedural details, and size/location/distribution of small bowel hamartomas. Results Twenty-three patients met our inclusion criteria. Of these, 18 (75%) had previously undergone small bowel surgery prior to index DAE. Between 2007 and 2020, 46 DAEs were performed in these patients with an average of one exam every 2.5 years. A total of 131 polypectomies were performed with an AE rate of 1.5%. None of our cohort required emergent surgery related to AEs of small bowel hamartomas over 336 years of aggregated follow-up. Conclusions Endoscopic management of small bowel polyps in patients with PJS using DAE is an effective strategy for prophylactic removal of hamartomas. DAE surveillance and endoscopic polypectomy is safe and may decrease the need for repeated laparotomy in patients with PJS.

Keywords: Laparoscopy; Small bowel endoscopy.

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