Efficacy And Safety Of Single-balloon Enteroscopy For Endoscopic Therapy Of Small Bowel Polyps In Patients With Peutz-Jeghers Syndrome

Background: Peutz-Jeghers syndrome（PJS）is a rare autosomal dominant hereditary disorder characterized by mucocutaneous melanin pigmentation and multiple gastrointestinal hamartomatous polyps.Hence,it is also called Polyps-and-Spots Syndrome.The incidence of this disease is estimated to be between 1 in 50000 to 1 in200000 live births.China has a large population base.Although the incidence of PJS is low,PJS patients are not in the minority.The mucocutaneous melanin pigmentation of PJS patients may affect their appearance,but do not affect their prognosis,and generally do not need to be treated.However,gastrointestinal hamartomatous polyps can affect the quality of life of PJS patients.Hamartomatous polyps can be detected in the whole gastrointestinal tract,most commonly in the small bowel.These hamartomatous polyps in the gastrointestinal tract can lead to bleeding,intussusception,and obstruction.Options to remove the polyps in the gastrointestinal tract include surgery and endoscopy.In the past,surgery was the only treatment for PJS gastrointestinal polyps.However,PJS polyps cannot be cured completely,patients often undergo multiple laparotomies with intestinal resection,which can ultimately result in short-bowel syndrome and/or severe adhesions.In 2001,the emergence of double-balloon enteroscopy made it possible to remove intestinal polyps under endoscopy,which can minimize the patient’s suffering.At present,some studies have confirmed the clinical application value of double-balloon enteroscopy in PJS patients.As a simplified approach to double-balloon assisted technology,Olympus company introduced single-balloon enteroscopy in 2007.The main advantages of singleballoon enteroscopy compared with double-balloon enteroscopy are ease of setup and shorter procedure time.Little is known about the clinical application value of singleballoon enteroscopy in PJS patients.The aim of this study was to assess the efficacy and safety of SBE for treatment of small bowel polyps in patients with PJS.Methods: We conducted a single center observational study in Zhejiang Provincial People’s Hospital,which included all patients diagnosed with PJS who underwent singleballoon enteroscopy for polypectomy between January 2018 and March 2021.Medical records of all the included patients were retrospectively reviewed.The following data were collected: age,gender,family history of PJS,history of laparotomy,history of malignancies,the method of SBE insertion,intubation depth,number of SBE procedures performed,maximum size and number of the resected polyps,and complications.Complete treatment was defined as the absence of polyps≥10mm after SBE resection.Patients were divided into children and adults according to their age.Statistical analysis was performed after the PJS database was established.Differences in numerical variables were analyzed by Student’s t-test or the Mann–Whitney U test.However,differences in categorical variables were analyzed by the χ2 test or Fisher’s exact test.The characteristics of PJS patients and the changes of the maximum diameter and number of polyps after single-balloon colonoscopy treatment were analyzed.The study protocol was reviewed and approved by the Institutional Review Board and Ethics Committee of Zhejiang Provincial People’s Hospital.Results: 102 PJS patients（including 8 children）with a mean age of 28.7 years（range 13–55 y）were enrolled in our study.The male/female sex ratio was 40/62.The intubation depth via oral approach of patients with history of laparotomy was significantly shorter than that of the patients without history of laparotomy（[241.6±64.2] cm vs [280.9±40.2]cm,P = 0.008）.The maximum size of the resected polyps via anus during the second hospitalization was significantly smaller than that during the first hospitalization（[2.25±1.29] cm vs [4.26±3.51] cm,P = 0.032）.For patients with total enteroscopy,the complete treatment rate was 98%（49/50）.For patients without total enteroscopy,all polyps≥10 mm in the examined segment of small bowel were resected successfully.Complications occurred in 10/129 of hospitalizations（4 delayed bleeding,3 perforation,and 3 acute pancreatitis）.Conclusions: SBE is effective and safe for resection of small bowel polyps in patients with PJS.Regular examination and treatment for PJS patients can effectively avoid the occurrence of intestinal polyp-related complications.