Long-Term Clinical Outcome of Ischemic Polypectomy in a Patient with Peutz-Jeghers Syndrome: A Case Report

Rodríguez-Hernández E1, Yamada M1,2*, Kakugawa Y1, Hirata M2 and Saito Y1

1Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
2Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan

^*Correspondance to: Masayoshi Yamada 

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Abstract:

Peutz-Jeghers Syndrome (PJS) is characterized by multiple gastrointestinal hamartomatous polyps, often leading to complications such as small bowel obstruction. We present a case of a 75-yearold male diagnosed with PJS, exhibiting numerous small bowel polyps. We implemented a novel treatment approach known as the Ischemic Polypectomy Technique. The patient underwent Double-Balloon Enteroscopy (DBE) using an underwater technique, involving clipping at the polyp base to induce ischemia and subsequent necrosis. Substantial reductions in both polyp count and size were observed during follow-up small bowel video capsule endoscopies at 5- and 17- months post-procedure. Notably, a decrease from 150 to 35 polyps and a reduction in size from 20 mm to 5 mm, coupled with observed polyp decapitation, demonstrated the efficacy of this method. Compared to conventional DBE polypectomy, the ischemic approach proved more accessible, quicker, and safer. While histopathological confirmation was unavailable due to non-retrieval of polyps, the observed morphological changes strongly indicated therapeutic efficacy. However, uncertainties persist regarding the extensive use of metal clips and associated costs. This case highlights the feasibility and effectiveness of endoscopic ischemic polypectomy for PJS-associated small bowel polyps. Despite potential limitations, this method shows promise in preventing complications associated with PJS, necessitating further case accumulation.

Keywords:

Peutz-Jeghers Syndrome; Hamartomatous polyps; Double Balloon Enteroscopy; Ischemic Polypectomy

Cite the Article:

Rodríguez-Hernández E, Yamada M, Kakugawa Y, Hirata M, Saito Y. Long- Term Clinical Outcome of Ischemic Polypectomy in a Patient with Peutz- Jeghers Syndrome: A Case Report. Ann Clin Case Rep. 2024; 9: 2582..