Management of duodenal-jejunal polyps in children with Peutz-Jeghers syndrome by using single balloon enteroscopy

BACKGROUND: Children with Peutz-Jeghers syndrome (PJS) have increased risk of polyp-related complications and emergency laparotomies. The aim of this study was to assess the efficacy and the safety of endoscopic therapy of small bowel polyps using single balloon enteroscopy (SBE) in children affected by PJS. METHODS: Between January 2010 and December 2011, prospectively consecutive PJS children with polyps larger than 15 mm or polyps actively bleeding previously identified using VCE and MRI underwent therapeutic SBE. The main outcome measurements were the feasibility, the technical performance and the safety. RESULTS: Ten children (6 male; median age: 13.7 years, range 5.6-15.6) underwent 23 SBE procedures. Four patients had a history of previous abdominal surgery. A total of 53 polyps were removed, and 23 of them were larger than 15 mm. The majority of polyps were found in jejunum (85%). The mean insertion depths for antegrade and retrograde approach were 200 ± 80 cm and 100 ± 50 cm beyond the ileal valve, respectively. The mean procedure time was 75 ± 25 minutes. Mild abdominal pain was reported after 3 procedures. In one patient a post-polipectomy perforation occurred. CONCLUSIONS: In conclusion, SBE is an effective endoscopic tool for treating small bowel polyps in children with PJS, and well-timed polypectomy might optimize patient's care preventing polyp-related complications and emergency laparotomy. Further larger multicenter studies are warranted to accurately determine the safety of therapeutic SBE in children.