Aims
Peutz-Jeghers syndrome (PJS) an autosomal dominant polyposis syndrome with a predisposition to hamartomatous polyps in the small bowel (SB) and emergent risk of intussusception, obstruction and intestinal surgery. The aim of this study is to examine outcomes of balloon-assisted enteroscopy (BAE) in Sheffield, UK, and published world data.
Methods
In Sheffield, patients undergoing BAE for PJS polypectomy between 1st January 2010 and 31st December 2025 were included. The number and maximum size of polyps removed, BAE-related complications, and rate of small bowel resection before and after BAE were examined. Published studies worldwide reporting these outcomes were examined.
Results
Table 1 highlights the outcomes of 18 published studies which included a total of 396 patients and 1100 BAE procedures for PJS polypectomy. Locally in Sheffield, 13 patients underwent 73 double-balloon enteroscopies (DBE) (59 antegrade, 14 retrograde) between 2010 and 2025. There was a mean of 5.6 procedures per patient during an observation time of 59 months (range 3-149 months). 69% (9/13) had a history of previous small bowel resection. A total of 179 polyps were removed with an average maximum polyp size of 20mm (range 10-60mm) and a mean of 2.5 polypectomies per procedure. The overall complication rate was 6.8% (5/73). Four complications were related to DBE (2 episodes of pancreatitis, 1 serositis and 1 aspiration pneumonitis). One complication occurred following polypectomy (bleeding from stalk requiring endoscopic therapy and transfusion). There were no perforations. One patient (7.7%) required elective small bowel resection due to failure to reach the polyp via DBE. During the period of follow-up, three patients died: one from metastatic adenocarcinoma of unknown primary, one after a Whipple’s procedure for a pancreatic cyst and one of unknown cause (suspected to be related to a small bowel stricture and cancer).
|
Year |
Country |
No. of patients |
No. of procedures |
Procedures per patient |
Median observation time (months) |
Prev GI surgery (no.) |
Single balloon enteroscopy |
Double balloon enteroscopy |
Total no of SB polypectomies |
Mean polypectomies per procedure |
Max polyp size (mm) |
No. of complications |
SB surgery post BAE |
|
2005 |
Japan |
2 |
5 |
2.5 |
|
2 |
|
5 |
18 |
3.6 |
60 |
2 |
|
|
2007 |
Germany |
16 |
47 |
2.9 |
|
|
|
47 |
47 |
1 |
50 |
4 |
1 |
|
2010 |
Japan |
18 |
80 |
4.4 |
54 |
14 |
|
80 |
387 |
4.8 |
50 |
6 |
|
|
2010 |
Netherlands |
13 |
29 |
2.2 |
19 |
11 |
|
29 |
79 |
2.7 |
50 |
0 |
1 (8%) |
|
2010 |
Czech Republic |
10 |
14 |
1.4 |
|
|
|
14 |
205 |
14.6 |
60 |
1 |
0 (0%) |
|
2011 |
Japan |
15 |
88 |
5.9 |
|
13 |
|
88 |
341 |
3.9 |
100 |
5 |
1 (6%) |
|
2011 |
Taiwan |
6 |
17 |
2.8 |
|
2 |
5 |
12 |
85 |
5.0 |
60 |
0 |
|
|
2012 |
Turkey |
7 |
30 |
4.3 |
|
7 |
|
30 |
110 |
3.7 |
100 |
1 |
|
|
2013 |
USA |
22 |
34 |
1.5 |
|
17 |
|
34 |
28 |
0.8 |
50 |
4 |
|
|
2013 |
Portugal |
25 |
46 |
1.8 |
56.5 |
14 |
|
46 |
214 |
4.7 |
50 |
3 |
7(28%) |
|
2014 |
Italy |
10 |
23 |
2.3 |
|
4 |
23 |
|
53 |
2.3 |
60 |
1 |
|
|
2014 |
Italy |
7 |
7 |
1 |
|
7 |
7 |
|
23 |
3.3 |
50 |
0 |
|
|
2018 |
Mexico |
4 |
12 |
3 |
|
|
7 |
5 |
35 |
2.9 |
40 |
1 |
|
|
2019 |
China |
97 |
320 |
3.3 |
46.7 |
57 |
|
320 |
1661 |
5.2 |
|
14 |
|
|
2019 |
Russia |
30 |
30 |
1 |
|
|
30 |
|
63 |
2.1 |
30 |
1 |
2 (6%) |
|
2020 |
Italy |
24 |
47 |
2 |
108 |
16 |
29 |
18 |
247 |
5.3 |
60 |
4 |
2 (8%) |
|
2024 |
US |
23 |
46 |
2 |
|
18 |
|
46 |
131 |
2.8 |
25 |
2 |
2 (9%) |
|
2025 |
South Korea |
22 |
115 |
5.2 |
|
9 |
|
115 |
362 |
3.1 |
70 |
5 |
|
|
2025 |
Japan |
45 |
110 |
2.4 |
|
14 |
|
110 |
792 |
7.2 |
|
9 |
11(24%) |
|
|
World |
396 |
1100 |
|
|
|
|
|
4881 |
|
|
63 (6%) |
|
Conclusions
Balloon-assisted enteroscopy is a safe and effective strategy for removing PJS small bowel hamartomas. Complications rates are around 6-7%. Small bowel surgery post BAE ranges between 0–28%. It is anticipated that BAE and polypectomy reduces small bowel surgery in patients with PJS, however outcomes of present studies are heterogenous.