Successful Polypectomy of Small Bowel Polyps in Patients with Peutz-Jeghers Syndrome Using Discovery Endoease SB Spiral Overtube (Spirus)

Abstract

Purpose: Small bowel polyps in Peutz-Jeghers Syndrome (PJS) have traditionally been managed either expectantly or with surgery. This has largely stemmed from the lack of any reliable endoscopic technology to reach and retrieve small bowel polyps. Double-balloon enteroscopy (DBE) and recently spiral overtube-assisted enteroscopy (Spirus) have emerged as new technologies to allow for endoscopic therapy of small bowel pathology. Methods: Two patients with PJS who had documented small bowel polyps on capsule endoscopy were enrolled. One patient had previous antegrade DBE with polyp resection, however more polyps were seen on repeat capsule study. In both cases, procedures were performed in the operating room using general endotreacheal anesthesia; the patient was positioned left-laterally. The enteroscopy was performed in an antegrade fashion using the Discovery EndoEase SB spiral overtube (Spirus Medical, Stoughton, MA). Results: The mean time to maximal insertion depth was 42±12 minutes. The mean polypectomy number was 3.5±2.1. The total procedure time was 140± 12 minutes. In one case, a tattoo site which marked the previous maximal depth of insertion by DBE was passed. There were no complications Conclusion: Spiral overtube-assisted enteroscopy is a valuable tool in small bowel endoscopy, and can aid in the successful resection of PJS polyps.