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Management of Duodenal–Jejunal Polyps in Children With Peutz-Jeghers Syndrome With Single-Balloon Enteroscopy

Bizzarri, Barbara*; Borrelli, Osvaldo; de’Angelis, Nicola*; Ghiselli, Alessia*; Nervi, Giorgio*; Manfredi, Marco*; de’Angelis, Gian Luigi*

Journal of Pediatric Gastroenterology & Nutrition: July 2014 - Volume 59 - Issue 1 - p 49–53
doi: 10.1097/MPG.0000000000000351
Original Articles: Gastroenterology

Objectives: Children with Peutz-Jeghers syndrome (PJS) have increased risk of polyp-related complications and emergency laparotomies. The aim of the present 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 >15 mm or polyps actively bleeding previously identified using video capsule endoscopy and magnetic resonance imaging underwent therapeutic SBE. The main outcome measurements were the feasibility, the technical performance, and the safety.

Results: A total of 10 children (6 boys; median age 13.7 years, range 5.6–15.6) underwent 23 SBE procedures. Four patients had a history of abdominal surgery. A total of 53 polyps were removed, and 23 of them were >15 mm. The majority of polyps were found in jejunum (85%). The mean insertion depths for antegrade and retrograde approach were 200 ± 80 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 1 patient a postpolypectomy perforation occurred.

Conclusions: In conclusion, SBE is an effective endoscopic tool for treating small bowel polyps in children with PJS, and well-timed polypectomy may optimize patients’ care, preventing polyp-related complications and emergency laparotomy. Further larger multicenter studies are warranted to accurately determine the safety of therapeutic SBE in children.

*Gastroenterology and Endoscopy Service, University of Parma, Parma, Italy

Department of Gastroenterology, Great Ormond Street Hospital, London, UK.

Address correspondence and reprint requests to Prof Gian Luigi de’Angelis, MD, Gastroenterology and Endoscopy Service, University of Parma, via Gramsci 14, 43100 Parma, Italy (e-mail:

Received 19 February, 2014

Accepted 19 February, 2014

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,