The Value Of Balloon-Assisted Enteroscopy In The Treatment And Surveillance Of Small-Bowel Polyps Of Children With Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome(PJS) is characterized by multiple hamartomatous polyps in gut and mucocutaneous black/brown pigmentation.Polyps in the small intestine often cause intestinal obstruction, intussusception and other serious complications such as bleeding and malignant. In the past,PJS patients with gastric polyps or colon polyps can be removed by gastroscope and colonoscopy,polyps in the small intestine removed through surgical,patients with PJS had to suffer after carried out surgery many times, surgery caused serious complications which include postoperative intestinal adhesion, short bowel syndrome.The Balloon assisted enteroscopy(BAE) provided a new therapeutic tool after it appearde,Significance of BAE as methods for diagnosis and treatment in PJS patients has been widely accepted at home and abroad. But the research of BAE therapeutic for children with PJS patients which lacked of large sample size.The purposes of this study were:To assess the value of balloon-assisted endoscopy(BAE) in the treatment and surveillance of small intestinal polyps of children with Peutz-Jeghers syndrome(PJS).A prospective study was performed in 216 patients with PJS who were treated at Air Force Hospital from April 2004 to September 2015.There were 56 children with PJS in pediatric group and 160 adult patients with PJS in adult group.The patients of two group were all treatment and surveillance by BAE,The main measurements included completion of BAE,the number of resected polyps,the size of resected polyps,the location of resected polyps,polypectomy technique,complications and patient Follow-up.The clinical data of two groups were analyzed retrospectively and compared.A total of 153 BAE procedures(93 peroral and 60 peranal) were carried out in 53 of 56 children with PJS, other 3 cases were received the diagnosis and treatment by gastroscope or colonoscopy only.there were 5 cases(2 peroral and 3 peranal) of children with PJS who carried out BAE did not reach the appointed depth and the operation successful rate was 90.6%.The detectable rate of intestinal polyps(?10mm) is 75.3%.and a total of 757 small intestinal polyps were removed by BAE.The resection rate of intestinal polyps(?10mm) is 77.1%. The clean removal rate of intestinal polyps(?10mm) is 62.5%.The incidences of intraoperative hemorrhage, postoperative hemorrhage and perforation were 17.0%(9/53), 7.5%(4/53) and 9.4%(5/53), respectively. A total of 418 BAE procedures(248 peroral and 170 peranal) were carried out in 150 of 160 adult patients with PJS, other 10 cases were received the diagnosis and treatment by gastroscope or colonoscopy only.There were 3 cases(1 peroral and 2 peranal) of adult with PJS who carried out BAE did not reach the appointed depth and the operation successful rate was 98.0%.The detectable rate of intestinal polyps(?10mm) is 77.9%.and a total of 2320 small intestinal polyps were removed by BAE.The resection rate of intestinal polyps(?10mm) is 79.1%.The clean removal ratio of intestinal polyps(?10mm) is 69.4%.The incidences of intraoperative hemorrhage, postoperative hemorrhage and perforation were 19.33%(9/53), 7.5%(4/53) and 5.4%(5/53), respectively. There were no significant differences in the rate of detectable polyps of intestine(?10mm),clean removal of intestinal polyps(?10mm)between pediatric group and adult group.There were no significant differences in the incidences of intraoperative hemorrhage and postoperative hemorrhage between pediatric group and adult group(p>0.05). The incidence of perforation was higher in pediatric group than that in adult group(p<0.05).Despite the risks, it is effective and safe for pediatric patients to receive BAE endoscopic therapy of intestinal polyps,it has important value for treatment and surveillance of small intestinal polyps in patients with PJS.