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Comparison of intraoperative enteroscopy and double-balloon enteroscopy for the diagnosis and treatment of Peutz-Jeghers syndrome

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Abstract

Background

Double-balloon enteroscopy (DBE) is an enteroscopy method that allows examination and treatment of the small bowel. Intraoperative enteroscopy (IOE) was the only possibility of endoscopic treatment for patients with Peutz-Jeghers syndrome (PJS) before the DBE era. PJS is an inherited, autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions. PJS predisposes sufferers to various malignancies. Bleeding, obstruction, and intussusception are common complications in patients with PJS. The goal of this study was compare our experience in diagnosis and treatment of small-bowel hamartomas by means of DBE and IOE.

Methods

From 1999 to 2006, we performed seven IOEs in seven patients (four women, three men), and since 2006, 14 DBEs in another ten patients (seven women, three men).

Results

A total of 182 polyps were removed during IOEs: 179 by the endoscopist and three were cut out by the surgeon. From 6 to 75 polyps were removed per session (mean, 26). The largest hamartoma measured 4 cm in diameter. The age of the patients ranged from 20 to 50 (mean, 31) years. In our DBE group, a total of 205 polyps were removed. From 1 to 37 polyps were removed per session (mean, 13). The age of the patients ranged from 12 to 48 (mean, 25) years. The largest hamartoma was 6 cm in diameter. We had no serious complications both in the IOE and the DBE group.

Conclusions

Polypectomy using DBE may obviate the need for repeated urgent operations and small-bowel resections leading to short-bowel syndrome. Patients are indicated for prophylactic procedure and polypectomy of the entire small bowel. Both DBE and IOE facilitate exploration and treatment of the small intestine. DBE is less invasive and more convenient for the patient. Both procedures are generally safe and useful.

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Acknowledgments

This study was supported by research project MZO 00179906 from the Ministry of Health, Czech Republic.

Disclosures

Drs. Marcela Kopáčová, Jan Bureš, Alexander Ferko, Ilja Tachecí, and Stanislav Rejchrt have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. 2nd Department of Medicine, Faculty of Medicine at Hradec Králové, Charles University in Praha, University Teaching Hospital, Sokolská 581, Hradec Králové, 500 05, Czech Republic

    Marcela Kopáčová, Jan Bureš, Ilja Tachecí & Stanislav Rejchrt

  2. Department of Surgery, Faculty of Medicine at Hradec Králové, Charles University in Praha, University Teaching Hospital, Sokolská 581, Hradec Králové, 500 05, Czech Republic

    Alexander Ferko

Authors
  1. Marcela Kopáčová
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  2. Jan Bureš
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  3. Alexander Ferko
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  4. Ilja Tachecí
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  5. Stanislav Rejchrt
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Correspondence to Marcela Kopáčová.

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Kopáčová, M., Bureš, J., Ferko, A. et al. Comparison of intraoperative enteroscopy and double-balloon enteroscopy for the diagnosis and treatment of Peutz-Jeghers syndrome. Surg Endosc 24, 1904–1910 (2010). https://doi.org/10.1007/s00464-009-0868-6

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  • DOI: https://doi.org/10.1007/s00464-009-0868-6

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