title: Double-balloon enteroscopy in the management of patients with Peutz-Jeghers syndrome: a retrospective cohort multicenter study.
abstract: OBJECTIVE
  Little is known about the clinical impact of double-balloon enteroscopy (DBE) in patients with Peutz- Jeghers syndrome (PJS).The aim of this study was to assess the efficacy and safety of DBE in the management of small-bowel polyps in PJS patients.
  
  
  METHODS
  We conducted a multicentre, retrospective cohort study, which included all consecutive patients diagnosed with PJS who underwent DBE for polypectomy between January 2006 and August 2012. In all cases, previous videocapsule enteroscopy had shown at least one polyp ≥ 10 mm in size.
  
  
  RESULTS
  Twenty-five patients (13 men; median age 36 years; 14 with prior laparotomy) underwent 46 DBE procedures (1 to 5 per patient, 44 via oral route). Polypectomy was performed in 39/46 DBEs. A total of 214 polyps were removed (median-size 30 mm), with a median number of polypectomies per procedure of 5.0 (range 1-18). The estimated maximum-sizes of resected polyps significantly decreased at each session: 30.0, 25.0, 20.0, 15.0, and 17.5 mm (p = 0.02). In 7 DBEs no polypectomy was performed (4-only minor polyps detected; 3-endoscopic irresecability). Complications occurred in 3/39 of therapeutic procedures (2-minor delayed bleeding; 1-mucosal tear), all of them dealt with conservative or endoscopic therapy. Six patients underwent elective surgery post DBE due to polyps not amenable for endoscopic resection. There were no small-bowel polyp related complications during a median follow-up of 56.5 months.
  
  
  CONCLUSIONS
  DBE showed to be a safe and effective technique in the management of small-bowel polyps in PJS patients, allowing a presymptomatic and non-surgical approach.
authors.forename: Miguel
authors.initials: M
authors.lastname: Serrano
authors.forename: Susana
authors.initials: S
authors.lastname: Mão-de-Ferro
authors.forename: Rolando
authors.initials: R
authors.lastname: Pinho
authors.forename: Ricardo
authors.initials: R
authors.lastname: Marcos-Pinto
authors.forename: Pedro
authors.initials: P
authors.lastname: Figueiredo
authors.forename: Sara
authors.initials: S
authors.lastname: Ferreira
authors.forename: Isabel
authors.initials: I
authors.lastname: Claro
authors.forename: Miguel
authors.initials: M
authors.lastname: Mascarenhas-Saraiva
authors.forename: António
authors.initials: A
authors.lastname: Dias-Pereira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D058582:Double-Balloon Enteroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010580:Peutz-Jeghers Syndrome / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult