title: Nonsurgical management of small-bowel polyps in Peutz-Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy.
abstract: BACKGROUND
  The major problem in the management of Peutz-Jeghers syndrome (PJS) is small-bowel polyps, which can cause intussusception and bleeding. Double-balloon endoscopy (DBE) enables endoscopic resection of small-bowel polyps.
  
  
  OBJECTIVE
  The aim of this study was to determine the efficacy and safety of endoscopic management of small-bowel polyps in PJS patients by using DBE.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Single university hospital.
  
  
  METHODS
  Consecutive patients with PJS who underwent multiple sessions of DBE for evaluation or treatment of small-bowel polyps between September 2000 and April 2009.
  
  
  METHODS
  Endoscopic resection of small-bowel polyps in PJS patients was performed by using DBE.
  
  
  METHODS
  Efficacy, safety, and long-term laparotomy rate after the procedures were evaluated.
  
  
  RESULTS
  Fifteen patients (10 men, mean age 34.0 ± 15.8 years) underwent DBE for a mean 3.0 ± 1.0 sessions. The mean numbers of resected polyps larger than 20 mm significantly decreased as sessions advanced (first, 3.6; second, 1.3; third, 0.7; fourth, 0.4; and fifth, 1.0; P = .02). The mean maximum sizes of resected polyps also significantly decreased at each session: 33, 19, 12, 17, and 30 mm (P = .01). One patient had a perforation, but was managed conservatively. Other complications were pancreatitis (n = 2) and bleeding (n = 2). Only 1 patient underwent surgery for intussusception during the study period.
  
  
  CONCLUSIONS
  This was a small single-center retrospective study of short duration.
  
  
  CONCLUSIONS
  Endoscopic management of small-bowel polyps in PJS patients by using DBE is safe and effective and avoids urgent laparotomy.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Miyata
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Nishimura
authors.forename: Hakuei
authors.initials: H
authors.lastname: Shinhata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sato
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000150:complications / Q000473:pathology / Q000628:therapy*; D007443:Intussusception / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010580:Peutz-Jeghers Syndrome / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult