Clinical analysis of small bowel polyps in patients with Peutz-Jeghers syndrome treated with double balloon enteroscopy
-
摘要:
目的 探讨双气囊小肠镜(DBE)对黑斑息肉综合征(PJS)患者小肠息肉治疗的效果及安全性。 方法 回顾性分析2020年6月—2023年11月于安徽医科大学第一附属医院消化内科接受DBE治疗的PJS患者临床资料,统计患者小肠息肉切除成功率、术中及术后并发症发生情况。 结果 共纳入12例患者(男性7例,女性5例),年龄为(29.94±13.29)岁。12例患者共进行20例次DBE检查及治疗(15例次经口进镜,5例次经肛进镜)。经口和经肛入镜的插管深度分别为(306.00±126.71)cm和(220.00±34.64)cm。12例患者息肉以空肠多见(100.0%),其中伴有胃息肉2例(16.7%),伴有结肠息肉2例(16.7%)。小肠息肉数目不等,大小不一,最大的息肉直径为5.0 cm,最小为0.3 cm。息肉切除成功率为100.0%,且无内镜下治疗相关严重并发症。5例患者有2次或2次以上住院治疗记录,第2次住院切除息肉的最大直径与第1次住院[(1.70±0.98)cm vs. (2.67±0.58)cm]比较,尽管差异无统计学意义(t=1.467,P=0.216),但相较于第1次住院息肉直径有缩小的趋势。随访结果发现DBE术后患者未见小肠息肉引起的肠套叠或肠梗阻记录。 结论 DBE可有效切除PJS患者小肠息肉,且治疗具有良好的安全性。 Abstract:Objective To investigate the efficacy and safety of double balloon enteroscopy (DBE) in the treatment of small intestinal polyps in patients with Peutz-Jeghers syndrome (PJS). Methods A retrospective analysis was conducted on PJS patients who underwent DBE at the Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, from June 2020 to November 2023. Clinical data of the patients were collected, and the success rate of small intestinal polyps resection as well as the incidence of intraoperative and postoperative complications were recorded. Results A total of 12 patients (7 males, 5 females) with a mean age of (29.94±13.29) years were included in our study. A total of 20 DBE procedures were performed (15 via the oral approach, and 5 via the anal approach). The mean intubation depth were (306.00±126.71) cm and (220.00±34.64) cm, respectively. Among the 12 patients, jejunum polyps were most common (100.0%), with gastric polyps observed in 2 cases (16.7%) and colonic polyps in 2 cases (16.7%). The number and size of small intestinal polyps varied, with the largest measuring approximately 5.0 cm in diameter and the smallest 0.3 cm. The success rate of polypectomy was 100.0%, and no serious complications were associated with endoscopic treatment. Five patients had two or more hospitalizations, with no significant difference in the maximum polyps diameter between the first and second hospitalizations [(1.70±0.98) cm vs. (2.67±0.58) cm, t=1.467, P=0.216], though a decreasing trend was observed. Follow-up results revealed that no cases of intussusception or intestinal obstruction caused by small bowel polyps after DBE. Conclusion DBE is an effective and safe method for the removal of small bowel polyps in patients with PJS. -
Key words:
- Peutz-Jeghers syndrome /
- Double balloon enteroscopy /
- Endoscopy /
- Small intestine polyps
-
表 1 12例PJS患者小肠息肉的分布情况
Table 1. Distribution of small bowel polyps in 12 patients with PJS
患者序号 息肉位置 1 十二指肠、空肠 2 胃、十二指肠、空肠、回肠 3 空肠、十二指肠 4 空肠、十二指肠 5 胃、十二指肠、空肠、回肠、结肠 6 空肠 7 空肠 8 空肠、回肠 9 空肠 10 空肠、回肠、结肠 11 十二指肠、空肠 12 空肠、回肠 表 2 12例PJS患者DBE治疗情况
Table 2. Status of DBE treatment in 12 patients with PJS
患者序号 住院次数 DBE例次 进镜方式 进镜深度(cm) 息肉最大直径(cm) 1 1 1 经口 350 2.5 2 1 2 经口 120 3.0 2 3 经肛 200 2.0 3 4 经口 360 2.5 3 1 5 经口 280 1.5 4 1 6 经口 130 5.0 5 1 7 经肛 200 2.0 1 8 经口 260 1.5 2 9 经肛 220 0.6 2 10 经口 260 3.0 6 1 11 经口 270 4.0 7 1 12 经口 350 4.5 8 1 13 经口 500 1.5 2 14 经肛 280 1.5 9 1 15 经口 420 3.0 2 16 经口 300 2.0 10 1 17 经肛 200 1.2 2 18 经口 210 4.0 11 1 19 经口 200 5.0 12 1 20 经口 580 2.3 -
[1] YAMAMOTO H, SAKAMOTO H, KUMAGAI H, et al. Clinical guidelines for diagnosis and management of Peutz-Jeghers syndrome in children and adults[J]. Digestion, 2023, 104(5): 335-347. doi: 10.1159/000529799 [2] TACHECI I, KOPACOVA M, BURES J. Peutz-Jeghers syndrome[J]. Curr Opin Gastroenterol, 2021, 37(3): 245-254. doi: 10.1097/MOG.0000000000000718 [3] LATCHFORD A R, CLARK S K. Gastrointestinal aspects of Peutz-Jeghers syndrome[J]. Best Pract Res Clin Gastroenterol, 2022, 58-59: 101789. DOI: 10.1016/j.bpg.2022.101789. [4] 唐绪荣, 黄爱玲, 吴树泉, 等. 黑斑息肉综合征癌变一例[J]. 临床内科杂志, 2019, 36(11): 785-786.TANG X R, HUANG A L, WU S Q, et al. A case of carcinoma in Peutz-Jeghers syndrome[J]. Journal of Clinical Internal Medicine, 2019, 36(11): 785-786. [5] ZHAO L, YIN A N, LIAO F, et al. Achieving total enteroscopy by consecutive bidirectional double-balloon enteroscopy procedures[J]. Curr Med Sci, 2022, 42(1): 144-149. doi: 10.1007/s11596-022-2523-6 [6] LUCACIU L A, SKAMNELOS A, MURINO A, et al. Life-threatening small-bowel diverticular bleed treated by double-balloon enteroscopy in a patient refusing transfusion[J]. Endoscopy, 2024, 56(S 01): E69. DOI: 10.1055/a-2224-7759. [7] YIN A N, ZHAO L, DING Y J, et al. Emergent double balloon enteroscopy in overt suspected small bowel bleeding: diagnosis and therapy[J]. Med Sci Monit, 2020, 26: e920555. DOI: 10.12659/MSM.920555. [8] LATCHFORD A, COHEN S, AUTH M, et al. Management of Peutz-Jeghers syndrome in children and adolescents: a position paper from the ESPGHAN polyposis working group[J]. J Pediatr Gastroenterol Nutr, 2019, 68(3): 442-452. doi: 10.1097/MPG.0000000000002248 [9] XIAO N J, ZHANG T Z, ZHANG J, et al. Proposal of a risk scoring system to facilitate the treatment of enteroenteric intussusception in Peutz-Jeghers syndrome[J]. Gut Liver, 2023, 17(2): 259-266. doi: 10.5009/gnl210390 [10] WANG Y X, BIAN D J, ZHU H Y, et al. The role of double-balloon enteroscopy in reducing the maximum size of polyps in patients with Peutz-Jeghers syndrome: 12-year experience[J]. J Dig Dis, 2019, 20(8): 415-420. doi: 10.1111/1751-2980.12784 [11] ONUMA K, SUDO G, INOUE H, et al. Double-balloon enteroscopy-assisted polypectomy for a solitary jejunal Peutz-Jeghers polyp causing anemia[J]. Endoscopy, 2022, 54(S02): E906-E907. DOI: 10.1055/a-1866-3758. [12] ALSAMMAN M A, FERREIRA J D, MOUSTAFA A, et al. Successful endoscopic reduction of an ileocolonic intussusception in an adult with Peutz-Jeghers syndrome[J]. Gastroenterology Res, 2019, 12(1): 40-42. doi: 10.14740/gr1130 [13] XU Z X, JIANG L X, CHEN Y R, et al. Clinical features, diagnosis, and treatment of Peutz-Jeghers syndrome: experience with 566 Chinese cases[J]. World J Gastroenterol, 2023, 29(10): 1627-1637. doi: 10.3748/wjg.v29.i10.1627 [14] CORTEGOSO VALDIVIA P, RONDONOTTI E, PENNAZIO M. Safety and efficacy of an enteroscopy-based approach in reducing the polyp burden in patients with Peutz-Jeghers syndrome: experience from a tertiary referral center[J]. Ther Adv Gastrointest Endosc, 2020, 13: 263177452091 9369. DOI: 10.1177/2631774520919369. [15] FUNAYAMA Y, SHINOZAKI S, YANO T, et al. Advancements in endoscopic management of small-bowel polyps in Peutz-Jeghers syndrome and familial adenomatous polyposis[J]. Therap Adv Gastroenterol, 2023, 17: 17562848231218561. DOI: 10.1177/17562848231218561. -

计量
- 文章访问数: 1
- HTML全文浏览量: 1
- PDF下载量: 1
- 被引次数: 0