Discussion
Our study showed that polyps larger than 10 mm in small bowel can be
resected effectively. SBE is effective and safe for resection of small
bowel polyps in patients with PJS. Treatment of small bowel polyps in
PJS has evolved over the past decades. Before enteroscopy development,
patients with PJS often underwent acute or elective operations for
elective intestinal resection. Hinds et al reported that 68% of
PJS patients underwent a laparotomy because of obstruction before the
age of 18 years[22]. In our study, 80.4% of patients had undergone
at least one laparotomy. In addition, the risks of gastrointestinal and
non-gastrointestinal malignancies significantly increase in patients
with PJS[8,9]. In our study, 18 (17.6%) patients were diagnosed
with cancer (breast cancer in three, colorectal cancer in three, and
ovarian cancer in two, lung cancer in two, thyroid cancer in two,
Cervical cancer in two, duodenal malignancy in two, and gastric cancer
in two). Therefore, except for surveillance of the small bowel, regular
check-up on other organs of these patients may be important.
Success rates of total enteroscopy of DBE were reported to be 40% to
80%[23,24]. In our study, the success rate of total enteroscopy was
42.4%, probably because of high rate of previous laparotomies in these
patients. Hence, we compared the intubation depth between patients with
history of laparotomy and patients without history of laparotomy. We
found that intubation depth via oral approach of patients with history
of laparotomy was significantly shorter than that of the patients
without history of laparotomy ([241.6±64.2] cm vs [280.9±40.2]
cm, P = 0.008). Intraabdominal adhesions would influence the motion of
small bowel within the abdominal cavity, impacting the intubation depth
of SBE. Laparotomies should be avoided if at all possible. The
complication rate (7.8%) of this study was slightly higher than that
previously reported by Sakamoto et al (6.8%)[14] and Mensink
et al (4.3%)[25]. The key point may be that most of SBE procedures
involved polypectomies of multiple large polyps, which were technically
challenging. After conservative therapy or surgical operations, these
patients had favorable final outcomes. Regarding the complication of
children, only one perforation occurred among the 8 patients. The
complication rate was not increased for children as we reported in this
study. However, the SBE procedures in children with PJS are difficult.
The key reasons are as follows: One is narrow intestinal lumen, another
is thinner intestinal wall, and the third is sharper angle of
enteroscopy. The sample size of children was small, the safety of SBE in
children should be interpreted with caution.
The major limitation of this study was its retrospective and single
center design. However, due to its large number of patients and
polypectomies, it allows us to draw some conclusions regarding efficacy
and safety.