SO31: Do we still need surgery for treating small bowel polyps in Peutz-Jeghers Syndrome? A 13-years follow-up cohort

Elia Samaha1, Sophie Scialom1,4, Gabriel Rahmi1,4, Joel Edery1, Camille Savale1, Charles-André Cuenod 1,2,4 Jean-Marc Canard 1, Georgia Malamut 1,4, Pierre-Laurent-Puig 1,3,4, Christophe Cellier 1,4. On behalf of PRED-IdF Network.

1 – Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital. 20 rue Leblanc, 75015 Paris. 2 – Radiology Unit, Georges Pompidou European Hospital. 20 rue Leblanc, 75015 Paris.3 – Oncogenetic department, Georges Pompidou European Hospital. 20 rue Leblanc, 75015 Paris 4 – Paris Descartes University, Paris

Aim

Polypectomy during enteroscopy is the first line treatment of small bowel (SB) polyps in Peutz-Jeghers syndrome (PJS). Our aim was to assess the need for surgery in a PJS cohort after joining a specialized screening network.

Method

Between 2002 and 2015, 25 PJS patients (F/M = 11/14, mean age=36, mean follow-up 60 months (2-139)), were screened every 2 to 3 years and polypectomy using device-assisted enteroscopy (DAE) was attempted each time a polyp > 1 cm was detected. In case of failure or incomplete resection, intra-operative enteroscopy (IOE) or surgical resection was performed.

Results

23/25 patients (92%) had 42 capsule endoscopies, and 14/25 patients (57%) had 23 magnetic resonance enterography (MRE) or computed tomography enteroclysis (CTE). A total of 50 DAE (42 per-oral and 8 per-anal) in all patients allowed the resection of 216 polyps. Endoscopic treatment was complete in 19/25 patients (76%). IOE was performed in another 4/25 patients (16%) allowing the resection of 58 polyps and a complete treatment in 92% of patients. SB surgical resection was finally indicated in 2/25 patients (8%), compared to 64% before screening (p<0,001).

Conclusion

DAE with IOE is sufficient in 92% of PJS patients for removing SB polyps. Surgical resection has become rare, but remains a good alternative for difficult cases.

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