Small Bowel Evaluation with Single Balloon Enteroscopy in Children with Peutz-Jeghers Syndrome

Abstract

Purpose: Patients with Peutz-Jeghers syndrome (PJS) have increased risk of polyp-related complications and emergency laparotomies, even in pediatric age. The aim of this study was to evaluate the safety and the efficacy of single balloon enteroscopy (SBE) in the evaluation and management of small bowel polyps in children affected by PJS. Methods: In the period of time between January 2010 and December 2011, 6 prospectively consecutive PJS children with actively bleeding polyps or large polyps (> 15 mm) showed by wireless capsule endoscopy or MRI underwent therapeutic SBE. All examinations were carried out with patients under general anesthesia with endotracheal intubation. The starting insertion route (anal or oral) of SBE was chosen according to the estimated location of the suspected lesions based on the previous VCE and MRI findings. Results: A total of 15 SBE procedures were performed. Four patients were male; the age ranges between 5.6-15.7 years with a median age of 13.8 years. Two patients had a history of previous abdominal surgery. 82% of polyps were found in the jejunum. The mean procedure time was 75±25 minutes. A total of 34 polyps were removed, and 13 of them were larger than 15 mm, with a maximum size of 6 cm. Mild abdominal pain was reported after 3 procedures, but no patients required therapy. One major complication (post-polypectomy perforation) occurred in one patient. Conclusion: SBE is effective for treating small bowel polyps in children with PJS, and it is useful to avoid polyp-related complications and subsequently emergency laparotomy. But since few data are reported in literature, especially in pediatric population, further larger multicenter studies are necessary.