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CHICAGO -- Video capsule endoscopy should be part of the long-term management of asymptomatic patients with Peutz-Jeghers Syndrome (PJS), as these patients have an increased risks for small and large bowel neoplasia, researchers reported here.
In 16 PJS patients, video capsule endoscopy identified polyps in the duodenum in 33%, in the jejunum in 80%, and in the ileum in 26%, according to Yasir Al-Azzawi, MD, of the University of Massachusetts Memorial Medical Center in Worcester, and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
is an inherited disorder that often results in hamartomatous polyps in the small and large intestine, which can cause bleeding and intestinal blockages.
"We believe this is the largest case series of patients with Peutz-Jeghers Syndrome involving video capsule endoscopy," Al-Azzawi said at a poster presentation at Digestive Disease Week 2017."These people develop these lesions a very young age. He noted that the mean age of patients in the study was 40.
The single center, chart review was conducted from 2006 to 2016, in PJS patients who underwent video capsule endoscopy. Most of the patients were women.
The most common indication for the video capsule endoscopy was PJS screening (11 patients) and unexplained anemia.
Nine of the patients underwent further evaluation using deep enteroscopy of the small intestine, and all but one of this subset of patients had polyps in the small intestine, the researchers reported. Colonoscopy was performed in 13 patients, and polyps were discovered in 11 of those individuals.
Seven resected polyps from the colon were hamartomatous and two were hyperplastic, the researchers reported. Four tumors resected from the duodenum were hamartomatous and 11 were hyperplastic. Of the other resected polyps in the small bowel, five were hamartomatous and one was hyperplastic.
"Video capsule endoscopy missed polyps in the stomach of six patients, which were detected by esophagogastroduodenoscopy, double balloon, or small intestine enteroscopy," Al-Azzawi reported, adding that "video capsule endoscopy is inferior to esophagogastroduodenoscopy for the detection of gastric polyps."
When polyps are found, "usually we remove the polyps with the double-balloon techniques, but we always have a surgeon on call in case we have a big polyp, or have complications," he said.
Al-Azzawi explained that six patients had polyps that were larger than 20 mm, and that there were complications, such as intussusception or small bowel obstruction, during polyp removal in four patients. He said that five of the patients had a history of complications with intussusception or small bowl obstruction, and all had jejunal polyps.
"We remove these polyps for fear that they could cause obstructions, or could develop into cancers," he said. His group noted that polyps of at least 20 mm in size, primarily in the jejunum, had a 67% complication rate in the study.
"What I found interesting about this study is that in these asymptomatic patients, they found a large number of polyps, including some quite large ones," said Ahmed Dehal, MD, of the John Wayne Cancer Center in Santa Monica, Calif. "These are people at high risk, and this video capsule endoscopy is a very non-invasive procedure. When we get patients like this, we do send them to have a video capsule endoscopy."
The authors acknowledged that the frequency of video capsule endoscopy in PJS patients still has to be determined.
Disclosures
Al-Azzawi and Dehal disclosed no relevant relationships with industry.
Primary Source
Digestive Disease Week
Al-Azzawi Y, et al "The utilization of video capsule endoscopy in patients with Peutz-Jeghers syndrome" DDW 2017; Abstract Su1214.