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Small-bowel Surveillance in Patients With Peutz-Jeghers Syndrome: Comparing Magnetic Resonance Enteroclysis and Double Balloon Enteroscopy

Goverde, Anne MD; Korsse, Susanne E. MD, PhD; Wagner, Anja MD, PhD; van Leerdam, Monique E. MD, PhD; Krak, Nanda C. MD, PhD; Stoker, Jaap MD, PhD; van Buuren, Henk R. MD, PhD; Hofstra, Robert M.W. PhD; Bruno, Marco J. MD, PhD; Dewint, Pieter MD, PhD; Dekker, Evelien MD, PhD; Spaander, Manon C.W. MD, PhD

Journal of Clinical Gastroenterology: April 2017 - Volume 51 - Issue 4 - p e27–e33
doi: 10.1097/MCG.0000000000000592
ONLINE ARTICLE: Original Article

Background and Study Aims: Small-bowel surveillance with polypectomy of polyps ≥15 mm prevents complications in patients with Peutz-Jeghers syndrome (PJS). We aimed to compare magnetic resonance enteroclysis (MRE) and double balloon enteroscopy (DBE) for diagnostic yield of these polyps and for patient preference.

Materials and Methods: PJS patients prospectively underwent MRE followed by proximal DBE within 20 weeks. Endoscopists were blinded to the MRE results. We compared number of polyps ≥15 mm detected by MRE and DBE. Patients’ perceptions of both procedures were assessed using questionnaires.

Results: Fifteen PJS patients (67% males, median age 47 y) underwent both MRE and DBE. Polyps ≥15 mm were identified by MRE and/or DBE in 12/15 (80%) patients. There was no significant difference in the detection of polyps ≥15 mm (38 by MRE vs. 50 by DBE, P=0.37). Sensitivity for these polyps was 62% (38/61) for MRE and 82% (50/61) for DBE. Patients’ perceived shame and burden did not differ significantly between MRE and DBE. Patients reported significantly more pain during preparation for MRE than for DBE (moderate vs. no pain, P=0.02), although perceived pain during the procedures was comparable (both mild, P=0.89). For future small-bowel surveillance 10/13 (77%) patients preferred DBE over MRE (P=0.09).

Conclusions: Our results suggest that MRE and DBE have a comparable diagnostic yield of polyps ≥15 mm. However, DBE allows for direct intervention and was preferred over MRE by most patients in this series. Larger cohorts of PJS patients are needed to fully evaluate the diagnostic yield of DBE compared with other modalities.

Departments of *Gastroenterology and Hepatology

Clinical Genetics

Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam

Departments of §Radiology

Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

Present address: Monique E. van Leerdam, MD, PhD, Department of Gastroenterology and Hepatology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, the Netherlands.

Present address: Pieter Dewint, MD, PhD, Department of Gastroenterology and Hepatology, AZ Maria-Middelares, Ghent, Belgium.

The authors declare that they have nothing to disclose.

Address correspondence to: Manon C.W. Spaander, MD, PhD, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Room Hs-306, P.O. Box 2040 3000 CA, Rotterdam, The Netherlands (e-mail: v.spaander@erasmusmc.nl).

Received December 10, 2015

Accepted June 3, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.