title: Small-bowel Surveillance in Patients With Peutz-Jeghers Syndrome: Comparing Magnetic Resonance Enteroclysis and Double Balloon Enteroscopy.
abstract: OBJECTIVE
  Small-bowel surveillance with polypectomy of polyps ≥15 mm prevents complications in patients with Peutz-Jeghers syndrome (PJS). We aimed to compare magnetic resonance enteroclysis (MRE) and double balloon enteroscopy (DBE) for diagnostic yield of these polyps and for patient preference.
  
  
  METHODS
  PJS patients prospectively underwent MRE followed by proximal DBE within 20 weeks. Endoscopists were blinded to the MRE results. We compared number of polyps ≥15 mm detected by MRE and DBE. Patients' perceptions of both procedures were assessed using questionnaires.
  
  
  RESULTS
  Fifteen PJS patients (67% males, median age 47 y) underwent both MRE and DBE. Polyps ≥15 mm were identified by MRE and/or DBE in 12/15 (80%) patients. There was no significant difference in the detection of polyps ≥15 mm (38 by MRE vs. 50 by DBE, P=0.37). Sensitivity for these polyps was 62% (38/61) for MRE and 82% (50/61) for DBE. Patients' perceived shame and burden did not differ significantly between MRE and DBE. Patients reported significantly more pain during preparation for MRE than for DBE (moderate vs. no pain, P=0.02), although perceived pain during the procedures was comparable (both mild, P=0.89). For future small-bowel surveillance 10/13 (77%) patients preferred DBE over MRE (P=0.09).
  
  
  CONCLUSIONS
  Our results suggest that MRE and DBE have a comparable diagnostic yield of polyps ≥15 mm. However, DBE allows for direct intervention and was preferred over MRE by most patients in this series. Larger cohorts of PJS patients are needed to fully evaluate the diagnostic yield of DBE compared with other modalities.
authors.affiliation: Departments of *Gastroenterology and Hepatology †Clinical Genetics ‡Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam Departments of §Radiology ∥Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Goverde
authors.forename: Susanne E
authors.initials: SE
authors.lastname: Korsse
authors.forename: Anja
authors.initials: A
authors.lastname: Wagner
authors.forename: Monique E
authors.initials: ME
authors.lastname: van Leerdam
authors.forename: Nanda C
authors.initials: NC
authors.lastname: Krak
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Henk R
authors.initials: HR
authors.lastname: van Buuren
authors.forename: Robert M W
authors.initials: RM
authors.lastname: Hofstra
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: Pieter
authors.initials: P
authors.lastname: Dewint
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.forename: Manon C W
authors.initials: MC
authors.lastname: Spaander
mesh_terms: D058582:Double-Balloon Enteroscopy; D020776:Endoscopes, Gastrointestinal; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D007417:Intestinal Polyps / Q000000981:diagnostic imaging* / Q000473:pathology; D007580:Jejunal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010580:Peutz-Jeghers Syndrome / Q000150:complications*; D012680:Sensitivity and Specificity