title: Performance of double-balloon enteroscopy for the management of small bowel polyps in hamartomatous polyposis syndromes.
abstract: OBJECTIVE
  Hamartomatous polyposis syndromes (HPS) are a group of rare inherited autosomal dominant disorders. Small bowel polyposis is one of the manifestations of HPS. Double-balloon enteroscopy (DBE) with polypectomy may obviate repeated small bowel surgeries for polyp intussusception, obstruction, or bleeding. The efficacy and safety of DBE-assisted polypectomy in HPS patients with clinically significant small bowel polyposis were evaluated.
  
  
  METHODS
  All HPS patients who underwent DBE from January 2007 to April 2011 were identified using a prospectively maintained database. Data on patient demographics, pre-DBE radiological studies, polyp characteristics, procedural outcomes, and complications were abstracted.
  
  
  RESULTS
  Twenty-two patients underwent a total of 34 DBE procedures. Pre-DBE imaging included computed tomography enterography (n = 15), computed tomography enteroclysis (n = 5), small bowel follow-through (n = 1), and magnetic resonance enterography (n = 1). Any small bowel polyp ≥ 1 cm in size on radiological imaging was referred for DBE-assisted polypectomy. Antegrade and retrograde DBE were successful in reaching and resecting targeted polyps in 90% (18/20) and 71.4% (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy was 82.3% (95% confidence interval: 66.5-91.6%). The median size of resected polyps was 2 cm (range 1-5 cm) and all were hamartomas. Minor adverse events occurred in four (11.8%) procedures, including abdominal pain (n = 2), immediate post-polypectomy bleeding (n = 1), and self-limited hematochezia (n = 1).
  
  
  CONCLUSIONS
  DBE-assisted polypectomy was successful in over 80% of HPS patients with an acceptable margin of safety. To the knowledge of the authors, this is one of the largest single-center studies to report on the performance and safety of DBE-assisted polypectomy in HPS patients.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Emmanuel C
authors.initials: EC
authors.lastname: Gorospe
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rajan
authors.forename: Louis-Michel
authors.initials: LM
authors.lastname: Wong Kee Song
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010580:Peutz-Jeghers Syndrome / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult