Safety Evaluation Of Balloon Assisted Enteroscopy For Small Bowel Polyps In Patients With Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome(Peutz-Jeghers syndrome, PJS),clinically rare, is an autosomal dominant genetic disease. The incidence rate is about1/200,000. The majority of patients(70% to 80%) suffer with PJS as the result of gene mutation in serine/threonine protein kinase 11(serine /threonine protein kinase 11, STK11). PJS is characterized by multiple hamartomatous polyps in gut and mucocutaneous black / brown pigmentation.It was first discovered in 1896 when by Hutchinson when both of a pair of twin sisters showed black / brown pigmentation in lips and oral mucosa. And in 1954, the disease was officially named as PJS. Its manifestations varies from asymptomatic status to severe abdominal pain,diarrhea, bloody diarrhea and others.Polyps in PJS patients may occur in any location of gastrointestinal tract. Polyps in the small intestine(jejunum>ileum> duodenum) is the most common, which followed by colon, stomach and rectum. Size of polyps ranges and may be as large as10 cm. Larger ones often cause intestinal obstruction, intussusception and other serious complications such as bleeding and malignant.Conservative treatment, surgery and endoscopic therapy are traditional methods for polyps in PJS. Among them, surgery is more precise, especially for intussusception, acute intestinal obstruction and non-urgent situation with clinical symptoms, but is macro-invasive, costly and with risks of complications such as adhesions and short bowel syndrome. Traditionally,polyps in stomach and colon can be removed via electronic gastroscope(EG) and electronic colonoscopy(EC) while those in small bowel are beyond the reach of EG and EC.Balloon assisted enteroscopy(BAE) includes Single-ballon enteroscopy(SBE) and Double-balloon enteroscopy(DBE); BAE realize the whole small intestine examination and intervention through both oral and anal way, which significantly improves the diagnostic yield of small bowel diseases. BAE has gradually become the gold standard for the diagnosis of small bowel disease, as it makes a reality that removing multiple intestinal polyps in PJS patients with endoscopy. Significance of BAE as methods for diagnosis and treatment in PJS patients has been widely accepted at home and abroad. Compared to other methods, BAE polypectomy is less invasive, shorter recovery duration and low cost. But,polypectomy in small intestine, especially when intestinal polyp is huge,has risks of complications such as bleeding, perforation and other complicated situations. Up to now, researches on safety evaluation of BAE used for polypectomy in small intestine of PJS patients are relatively with small size.This is a retrospective with a relativel large sample size, aiming to evaluate the safety of BAE polypectomy in intestinal of PJS. We analyzed the clinical data of 181 cases(the People’s Liberation Army Air Force General Hospital, 2004-04 / 2014-07). A total of 483 BAE were performed(285 through mouth way and 198 through anal way), by which 2680 polyps(diameter: 534polyps/19.9% ranging from 0.5cm to 1.0 cm; 1485polyps/55.4% ranging from 1.0cm to 3.0 cm; 531 polyps/19.8% ranging from 3.0cm to 5.0 cm; 130 polyps/4.8% larger than 5.0cm) were removed.After being treated by BAE, 397 procedures(83.2%) complicated with transient mild abdominal pain, bloating and / or abdominal discomfort,98 procedures(34.3%) complicated with transient sore throat, hoarseness,throat discomfort, etc.; 89 procedures(18.4%) complicated with postoperative fever(body temperature: 74 cases 37.3 ~ 38 ℃, 15 cases >38 ℃); seven procedures(1.5%) showed small intestine perforation; 58procedures(12.0%) showed bleeding during or after operation; only oneshowed acute pancreatitis after BAE procedure. Among procedures complicated with bleeding, 49 occurred during operation and bleeding were stopped by clipping through titanium clip, sub-ion plasma coagulation(asian ion plasma coagulation, APC), residual roots saline injection of adrenaline and so on; for 9 complicated with postoperative bleeding, the average time for bleeding was 96.89hours(SD=64.34hours), hemostatic drugs and endoscopic hemostasis were successful in stopping bleeding. No BAE procedure-related deaths occurred.The results of this study showed that polypectomy via BAE in small intestine of PJS patients with multiple polyps is safe and effective. To a certain extent, BAE makes a number of PJS patients avoid surgery and presents significant importance for the diagnosis and treatment in PJS polyps.