Performance of double-balloon enteroscopy for the management of small bowel polyps in hamartomatous polyposis syndromes

Emmanuel C. Gorospe, Jeffrey A. Alexander, David H. Bruining, Elizabeth Rajan, Louis Michel Wong Kee Song

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background and Aim: Hamartomatous polyposis syndromes (HPS) are a group of rare inherited autosomal dominant disorders. Small bowel polyposis is one of the manifestations of HPS. Double-balloon enteroscopy (DBE) with polypectomy may obviate repeated small bowel surgeries for polyp intussusception, obstruction, or bleeding. The efficacy and safety of DBE-assisted polypectomy in HPS patients with clinically significant small bowel polyposis were evaluated. Methods: All HPS patients who underwent DBE from January 2007 to April 2011 were identified using a prospectively maintained database. Data on patient demographics, pre-DBE radiological studies, polyp characteristics, procedural outcomes, and complications were abstracted. Results: Twenty-two patients underwent a total of 34 DBE procedures. Pre-DBE imaging included computed tomography enterography (n=15), computed tomography enteroclysis (n=5), small bowel follow-through (n=1), and magnetic resonance enterography (n=1). Any small bowel polyp ≥1cm in size on radiological imaging was referred for DBE-assisted polypectomy. Antegrade and retrograde DBE were successful in reaching and resecting targeted polyps in 90% (18/20) and 71.4% (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy was 82.3% (95% confidence interval: 66.5-91.6%). The median size of resected polyps was 2cm (range 1-5cm) and all were hamartomas. Minor adverse events occurred in four (11.8%) procedures, including abdominal pain (n=2), immediate post-polypectomy bleeding (n=1), and self-limited hematochezia (n=1). Conclusions: DBE-assisted polypectomy was successful in over 80% of HPS patients with an acceptable margin of safety. To the knowledge of the authors, this is one of the largest single-center studies to report on the performance and safety of DBE-assisted polypectomy in HPS patients.

Original languageEnglish (US)
Pages (from-to)268-273
Number of pages6
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume28
Issue number2
DOIs
StatePublished - 2013

Fingerprint

Double-Balloon Enteroscopy
Polyps
Safety
Tomography
Hemorrhage
Gastrointestinal Hemorrhage
Hamartoma
Intussusception
Abdominal Pain

Keywords

  • Cowden syndrome
  • Double-balloon enteroscopy
  • Hamartomatous polyps
  • Juvenile polyposis
  • Peutz-Jegher's syndrome

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Performance of double-balloon enteroscopy for the management of small bowel polyps in hamartomatous polyposis syndromes. / Gorospe, Emmanuel C.; Alexander, Jeffrey A.; Bruining, David H.; Rajan, Elizabeth; Wong Kee Song, Louis Michel.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 28, No. 2, 2013, p. 268-273.

Research output: Contribution to journalArticle

Gorospe, Emmanuel C. ; Alexander, Jeffrey A. ; Bruining, David H. ; Rajan, Elizabeth ; Wong Kee Song, Louis Michel. / Performance of double-balloon enteroscopy for the management of small bowel polyps in hamartomatous polyposis syndromes. In: Journal of Gastroenterology and Hepatology (Australia). 2013 ; Vol. 28, No. 2. pp. 268-273.
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abstract = "Background and Aim: Hamartomatous polyposis syndromes (HPS) are a group of rare inherited autosomal dominant disorders. Small bowel polyposis is one of the manifestations of HPS. Double-balloon enteroscopy (DBE) with polypectomy may obviate repeated small bowel surgeries for polyp intussusception, obstruction, or bleeding. The efficacy and safety of DBE-assisted polypectomy in HPS patients with clinically significant small bowel polyposis were evaluated. Methods: All HPS patients who underwent DBE from January 2007 to April 2011 were identified using a prospectively maintained database. Data on patient demographics, pre-DBE radiological studies, polyp characteristics, procedural outcomes, and complications were abstracted. Results: Twenty-two patients underwent a total of 34 DBE procedures. Pre-DBE imaging included computed tomography enterography (n=15), computed tomography enteroclysis (n=5), small bowel follow-through (n=1), and magnetic resonance enterography (n=1). Any small bowel polyp ≥1cm in size on radiological imaging was referred for DBE-assisted polypectomy. Antegrade and retrograde DBE were successful in reaching and resecting targeted polyps in 90{\%} (18/20) and 71.4{\%} (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy was 82.3{\%} (95{\%} confidence interval: 66.5-91.6{\%}). The median size of resected polyps was 2cm (range 1-5cm) and all were hamartomas. Minor adverse events occurred in four (11.8{\%}) procedures, including abdominal pain (n=2), immediate post-polypectomy bleeding (n=1), and self-limited hematochezia (n=1). Conclusions: DBE-assisted polypectomy was successful in over 80{\%} of HPS patients with an acceptable margin of safety. To the knowledge of the authors, this is one of the largest single-center studies to report on the performance and safety of DBE-assisted polypectomy in HPS patients.",
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AU - Alexander, Jeffrey A.

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AU - Wong Kee Song, Louis Michel

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N2 - Background and Aim: Hamartomatous polyposis syndromes (HPS) are a group of rare inherited autosomal dominant disorders. Small bowel polyposis is one of the manifestations of HPS. Double-balloon enteroscopy (DBE) with polypectomy may obviate repeated small bowel surgeries for polyp intussusception, obstruction, or bleeding. The efficacy and safety of DBE-assisted polypectomy in HPS patients with clinically significant small bowel polyposis were evaluated. Methods: All HPS patients who underwent DBE from January 2007 to April 2011 were identified using a prospectively maintained database. Data on patient demographics, pre-DBE radiological studies, polyp characteristics, procedural outcomes, and complications were abstracted. Results: Twenty-two patients underwent a total of 34 DBE procedures. Pre-DBE imaging included computed tomography enterography (n=15), computed tomography enteroclysis (n=5), small bowel follow-through (n=1), and magnetic resonance enterography (n=1). Any small bowel polyp ≥1cm in size on radiological imaging was referred for DBE-assisted polypectomy. Antegrade and retrograde DBE were successful in reaching and resecting targeted polyps in 90% (18/20) and 71.4% (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy was 82.3% (95% confidence interval: 66.5-91.6%). The median size of resected polyps was 2cm (range 1-5cm) and all were hamartomas. Minor adverse events occurred in four (11.8%) procedures, including abdominal pain (n=2), immediate post-polypectomy bleeding (n=1), and self-limited hematochezia (n=1). Conclusions: DBE-assisted polypectomy was successful in over 80% of HPS patients with an acceptable margin of safety. To the knowledge of the authors, this is one of the largest single-center studies to report on the performance and safety of DBE-assisted polypectomy in HPS patients.

AB - Background and Aim: Hamartomatous polyposis syndromes (HPS) are a group of rare inherited autosomal dominant disorders. Small bowel polyposis is one of the manifestations of HPS. Double-balloon enteroscopy (DBE) with polypectomy may obviate repeated small bowel surgeries for polyp intussusception, obstruction, or bleeding. The efficacy and safety of DBE-assisted polypectomy in HPS patients with clinically significant small bowel polyposis were evaluated. Methods: All HPS patients who underwent DBE from January 2007 to April 2011 were identified using a prospectively maintained database. Data on patient demographics, pre-DBE radiological studies, polyp characteristics, procedural outcomes, and complications were abstracted. Results: Twenty-two patients underwent a total of 34 DBE procedures. Pre-DBE imaging included computed tomography enterography (n=15), computed tomography enteroclysis (n=5), small bowel follow-through (n=1), and magnetic resonance enterography (n=1). Any small bowel polyp ≥1cm in size on radiological imaging was referred for DBE-assisted polypectomy. Antegrade and retrograde DBE were successful in reaching and resecting targeted polyps in 90% (18/20) and 71.4% (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy was 82.3% (95% confidence interval: 66.5-91.6%). The median size of resected polyps was 2cm (range 1-5cm) and all were hamartomas. Minor adverse events occurred in four (11.8%) procedures, including abdominal pain (n=2), immediate post-polypectomy bleeding (n=1), and self-limited hematochezia (n=1). Conclusions: DBE-assisted polypectomy was successful in over 80% of HPS patients with an acceptable margin of safety. To the knowledge of the authors, this is one of the largest single-center studies to report on the performance and safety of DBE-assisted polypectomy in HPS patients.

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