Management of small-bowel polyps in Peutz-Jeghers syndrome by using enteroclysis, double-balloon enteroscopy, and videocapsule endoscopy

Background: Management of small-bowel polyps in Peutz-Jeghers syndrome (PJS) by using fluoroscopic enteroclysis (FE), double-balloon enteroscopy (DBE), and videocapsule enteroscopy (VCE) remains incompletely determined. Objective: To evaluate the usefulness of FE, VCE, and DBE and compute the polyp growth rate. Design: Single-center retrospective study. Setting: Tertiary referral hospital. Patients: Between,June 2003 and January 2010, 18 consecutive patients with PJS were enrolled. Main Outcome Measurements: Polyp detection rates among FE, VCE, and DBE, histology of resected polyps, and the polyp growth rate. Results: Total enteroscopy rate was higher at VCE (89%) than at DBE (52%; 27% in patients with >= 2 previous laparotomies and 90% in patients with <= 1 [P =.001]). FE demonstrated fewer polyps than DBE, whereas VCE had detection rates similar to those of DBE. Of 387 DBE-resected and 22 surgically resected polyps, histologic analysis of 110 retrieved polyps showed adenoma or adenocarcinoma in 30.0% of polyps >20 mm and in only 1.3% of polyps <= 20 mm (P < .0001). Multiple linear regression analysis showed that the number of small-bowel polyps >10 mm (X1; P = .0366) and colorectal polyps >5 mm (X2; P = .002) were independent predictors of the growth rate of small-bowel polyps (Y), and a forward stepwise selection model was constructed: Y = 0.136 X X1 + 0.289 X X2 - 0.589 (R-2 = 0.665). Limitations: Small sample size. Conclusions: DBE and VCE were useful for the management of small-bowel polyps in PJS. VCE may replace barium examinations for surveillance after polyp resection at intervals depending on the polyp growth rate. (Gastrointest Enclose 2010;72:1209-16.)