Peutz- Jeghers sendromu olan hastalarda çift balon enteroskopinin etkinliği ve güvenliğinin değerlendirilmesi: Tek merkez deneyimi

Yıl 2024, Cilt: 23 Sayı: 3, 93 - 100, 25.12.2024

Mahmut Yüksel , Bayram Yeşil , Çağdaş Erdoğan Dilara Turan Gökçe , Ferhat Bacaksız , Alper Macif İlyas Tenlik , Ömer Öztürk , Derya Arı , Öykü Tayfur Yürekli , Meral Akdoğan Kayhan , Hale Gökcan

https://doi.org/10.17941/agd.1591271

Öz

Giriş ve Amaç: Peutz-Jeghers sendromlu bireylerde çift balon enteroskopinin klinik sonuçları hakkındaki bilgilerimiz sınırlıdır. Bu çalışmanın amacı, Peutz-Jeghers sendromlu hastalarda ince bağırsak poliplerinin yönetiminde çift balon enteroskopinin etkinliğini ve güvenliğini değerlendirmektir. Gereç ve Yöntem: Ocak 2007 ile Mart 2020 tarihleri arasında merkezimizde çift balon enteroskopi uygulanan 16 Peutz-Jeghers sendromlu hastanın verileri toplandı. Çalışmaya çapı 1 cm'den büyük polipleri olan hastalar dahil edildi. Bulgular: Peutz-Jeghers sendromlu 16 hastaya toplam 79 çift balon enteroskopi prosedürü uygulandı ve 76 oral/anal çift balon enteroskopide 1 cm'den büyük toplam 469 polip bulundu. İnce bağırsak segmentlerinde görülen 80'den fazla polip, intraoperatif çift balon enteroskopi sırasında endoskopik polipektomi kullanılarak çıkarıldı. Dört hastaya çift balon enteroskopiye ek olarak intraoperatif enteroskopi uygulanmış ve endoskopik polipektomi ile 200'den fazla polip çıkarılmıştır. 79 çift balon enteroskopi prosedürü sırasında veya sonrasında prosedürler ve anestezi ile ilgili toplam 19 komplikasyon meydana gelmiştir. Prosedürle ilgili tüm komplikasyonlar minimal invaziv yöntemlerle tedavi edilmiştir. Çift balon enteroskopi sonrasında iki hasta ameliyat edilmiştir (birinde invajinasyon, diğerinde adezyon ileusu). Sonuç: Çift balon enteroskopi, Peutz-Jeghers sendromlu hastaların tanı ve uzun dönem takibinde güvenilir ve etkili bir yöntem olarak kabul edilebilir.

Anahtar Kelimeler

Çift balon enteroskopi, Peutz-Jeghers sendromu, polip

Efficacy and safety of double balloon enteroscopy in patients with Peutz-Jeghers Syndrome: Single center experience

Öz

Background and Aims: Our understanding of the clinical outcomes of double balloon enteroscopy in individuals with Peutz-Jeghers syndrome is limited. The purpose of this study is to assess double balloon enteroscopy’s effectiveness and safety in managing small intestinal polyps in Peutz-Jeghers syndrome patients. Materials and Methods: Data from 16 Peutz-Jeghers syndrome patients who underwent double balloon enteroscopy at our center between January 2007 and March 2020 have been collected. The study included patients with polyps larger than 1 cm in diameter. Results: Sixteen patients with Peutz-Jeghers syndrome underwent a total of 79 double balloon enteroscopy procedures, and a total of 469 polyps larger than 1 cm were found in 76 oral/anal double balloon enteroscopies. Over 80 polyps seen in the small intestinal segments were removed using endoscopic polypectomy during intraoperative double balloon enteroscopy. Four patients underwent intraoperative enteroscopy in addition to double balloon enteroscopy and over 200 polyps were removed via endoscopic polypectomy. A total of 19 complications which was related with procedures and anesthesia occurred either during or after the 79 double balloon enteroscopy procedures. All procedure related complications were treated with minimally invasive methods. After double balloon enteroscopy, two patients underwent surgery (one with invagination, the other with adhesion ileus). Conclusion: Double balloon enteroscopy can be considered a reliable and effective method in the diagnosis and long-term follow-up of patients with Peutz-Jeghers syndrome.

Anahtar Kelimeler

Double balloon enteroscopy, Peutz-Jeghers syndrome, polyp

Kaynakça

• 1. Hemminki A, Markie D, Tomlinson I, et al. A serine / threonine kinase gene defective in Peutz-Jeghers syndrome. Nature. 1998;391(6663):184-7.
• 2. Giardiello FM, Trimbath JD. Peutze-Jeghers syndrome and managements. Clin Gastroenterol Hepatol. 2006;4(4):408-15.
• 3. Gammon A, Jasperson K, Kohlmann W, Burt RW. Hamartomatous polyposis syndromes. Best Pract Res Clin Gastroenterol. 2009;23(2):219-31.
• 4. Schreibman IR, Baker M, Amos C, McGarrity TJ. The hamartomatous polyposis syndromes: a clinical and molecular review. Am J Gastroenterol. 2005;100(2):476-90.
• 5. Van Lier MG, Westerman AM, Wagner A, et al. High cancer risk and increased mortality in patients with Peutz-Jeghers syndrome. Gut. 2011;60(2):141-7.
• 6. Beggs AD, Latchford AR, Vasen HF, et al. Peutz-Jeghers syndrome: A systematic review and recommendantions for management. Gut. 2010;59(7):975-86.
• 7. Yamamoto H, Kita H. Double-balloon endoscopy: From concept to reality. Gastrointest Endosc Clin N Am. 2006;16(2):347-61.
• 8. Sakamoto H, Yamamoto H, Hayashi Y, et al. Nonsurgical management of small-bowel polyps in Peutz-Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy. Gastrointest Endosc. 2011;74(2):328-33.
• 9. van Lier MG, Wagner A, Mathus-Vliegen EM, et al. High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations. Am J Gastroenterol. 2010;105(6):1258-64; author reply 1265.
• 10. Ohmiya N, Taguchi A, Shirai K, et al. Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy. Gastrointest Endosc. 2005;61(1):140-7.
• 11. Gao H, van Lier MG, Poley JW, Kuipers EJ, van Leerdam ME. Endoscopic therapy of small-bowel polyps by Peutz-Jeghers syndrome. Gastrointest Endosc. 2010;71(4):768-73.
• 12. Ohmiya N, Nakamura M, Takenaka H, et al. Management of small-bowel polyps in Peutz-Jeghers syndrome by using enteroclysis, double-balloon enteroscopy Gastrointest Endosc. 2010;72(6):1209-16.
• 13. Chan W, Wei LK, Tan T, Hsiang LG, Kong C, Salazar E, Koay D, Khor C, Asokkumar R. Motorized spiral enteroscopy versus double-balloon enteroscopy: a case-matched study. Gastrointest Endosc. 2023;97(2):314-24.
• 14. Li BR, Sun T, Li J, Zhang YS, Ning SB, Jin XW, Zhu M, Mao GP. Primary experience of small bowel polypectomy with balloon-assisted enteroscopy in young pediatric Peutz-Jeghers syndrome patients. Eur J Pediatr. 2020;179(4):611-7.
• 15. Belsha D, Urs A, Attard T, Thomson M. Effectiveness of Double-balloon Enteroscopy-facilitated Polypectomy in Pediatric Patients With Peutz-Jeghers Syndrome. J Pediatr Gastroenterol Nutr. 2017;65(5):500-2.
• 16. van Lier MG, Mathus-Vliegen EM, Wagner A, van Leerdam ME, Kuipers EJ. High cumulative risk of intussusception in patients with Peutz-Jeghers syndrome: time to update surveillance guidelines? Am J Gastroenterol. 2011;106(5):940-5.
• 17. Serrano M, Mão-de-Ferro S, Pinho R, et al. Double-balloon enteroscopy in the management of patients with Peutz-Jeghers syndrome: a retrospective cohort multicenter study. Rev Esp Enferm Dig. 2013;105(10):594-9.