Small bowel polyps in Peutz-Jeghers syndrome: management by combined push enteroscopy and intraoperative enteroscopy

Background: Polyps occur throughout the GI tract in Peutz-Jeghers syndrome; the major problem in the management of the syndrome lies in the small bowe l. Methods: From January 1979 to January 1998, seven patients with Peutz-Jeghe rs syndrome underwent surveillance. Between 1979 and 1992 they were managed with upper and lower endoscopy every 2 to 3 years and surgery when intesti nal obstruction occurred. From 1993 they also underwent enteroclysis and, o n the basis of radiologic findings, push enteroscopy and/or intraoperative enteroscopy. Push enteroscopy was then performed every 2 years in all patie nts. Results: During the first period, 5 of 7 patients underwent emergency small bowel resection (2 operated twice). The patients were divided into 2 group s based on enteroclysis findings; the first comprised 4 patients with multi ple polyps throughout the small bowel, and the second included 3 patients w ith polyps only in the proximal smart bower. Three of the 4 patients with d iffuse polyposis underwent intraoperative enteroscopy during which on avera ge 16 polyps per patient were removed (range 10 to 25 polyps; mean diameter 16 mm, range 3 to 50 mm). The remaining patient with diffuse polyposis had a single 25 mm polyp in the terminal ileum removed by retrograde ileoscopy ; the more proximal polyps were removed by push enteroscopy. The patients w ith diffuse polyposis remained asymptomatic during follow-up (mean 50 month s, range 47 to 57 months) and also underwent periodic push enteroscopy (mea n 2.25 enteroscopies per patient, range 2 to 3) at which a mean of 8.5 poly ps per patient (range 4 to 13 polyps) were removed (mean diameter 7.2 mm, r ange 3 to 15 mm). The 3 patients of the second group underwent periodic pus h enteroscopy alone (mean 3 per patient) during which a mean of 11.7 polyps per patient were removed (range 7 to 15 polyps: mean diameter 10.9 mm, ran ge 3 to 40 mm). Enteroclysis was not repeated in these patients, who remain ed asymptomatic during follow-up (mean 47 months, range 46 to 48 months). Conclusions: More effective clearance of small bowel polyps via enteroscopy wilt help reduce the need for emergency surgery with extensive intestinal resection in patients with Peutz-Jeghers syndrome.