title: Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy.
abstract: OBJECTIVE
  To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in patients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps.
  
  
  METHODS
  Seven consecutive asymptomatic pts (age 15-38 years) with PJS have been collected; six underwent polypectomy using single balloon enteroscopy (Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit (OBCU Olympus Balloon Control Unit) and a disposable silicone splinting tube with balloon (ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endoscopy (WCE). Prophylactic polypectomy was reserved mainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from -6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure.
  
  
  RESULTS
  Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm (range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgical resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussusceptions. No gastrointestinal tumors were found in subsequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper endoscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps (> 15 mm).
  
  
  CONCLUSIONS
  The effective of prophylactic polypectomy of small bowel large polyps (> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Torroni
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Erminia
authors.initials: E
authors.lastname: Romeo
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rea
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Paola De
authors.initials: PD
authors.lastname: Angelis
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Foschia
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Faraci
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Giovanni Federici di
authors.initials: GF
authors.lastname: Abriola
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Contini
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Tamara
authors.initials: T
authors.lastname: Caldaro
authors.affiliation: Filippo Torroni, Erminia Romeo, Francesca Rea, Paola De Angelis, Francesca Foschia, Simona Faraci, Giovanni Federici di Abriola, Anna Chiara Contini, Tamara Caldaro, Luigi Dall'Oglio, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Dall'Oglio
keywords: Balloon assisted enteroscopy; Peutz-Jeghers syndrome; Polypectomy