目的:息肉综合征如Peutz-Jeghers(PJ)和家族性腺瘤性息肉病(FAP)与小肠息肉的生长有关;PJ的风险约为60-90%,FAP的风险约为40-70%。这项研究的主要目的是评估设备辅助肠镜检查(DAE)在检测和治疗小肠息肉以降低手术风险方面的功效。次要目的是研究并发症和死亡率。
方法:我们通过分析结构化数据库进行了一项回顾性队列研究。在2006年9月至2019年10月之间,我们观察并随访了42例息肉病综合征患者;他们接受了设备辅助肠镜检查,其中3例在检查后被排除在择期手术之外。进行内窥镜检查是为了诊断和治疗目的。
结果:对39例患者进行了评估,平均随访时间为6.7年(±SD2.7),79.5%为女性,平均年龄为43.8岁(±SD15.02),进行了68次肠镜检查,切除了64个息肉样病变。一次手术肠镜检查后出血,6例PJ患者和5例FAP患者需要进行后续手术.PJ患者的手术指征是存在大息肉(3例)和3例肠套叠,其中一个病人在回肠近端有息肉,范围不可达。1例PJ患者在随访期间死于胰腺癌。FAP患者的手术指征是存在四个大息肉,高度异型增生和一个壶腹肿瘤复发。
结论:在PJ患者中,小肠息肉的内镜治疗是安全的。在后续期间,内镜治疗成功的患者不需要手术.在接受DAE治疗的FAP患者中,没有人患上癌症。
OBJECTIVE: Polyposis syndromes such as Peutz-Jeghers (PJ) and familial adenomatous polyposis (FAP) are associated with the growth of small bowel polyps; the risk is approximately 60-90% for PJ and 40-70% for FAP. The primary aim of this study was to evaluate the efficacy of device-assisted enteroscopy (DAE) in the detection and treatment of small bowel polyps to reduce the risk of surgery. The secondary objective was to study complications and mortality.
METHODS: We conducted a retrospective cohort study by analyzing a structured database. Between September 2006 and October 2019, we observed and followed 42 consecutive patients with polyposis syndromes; they underwent device-assisted enteroscopy and three were excluded from elective surgery after the exam. The endoscopic exams were performed for diagnostic and therapeutic purposes.
RESULTS: Thirty-nine patients were evaluated with a mean follow up of 6.7 years (±SD 2.7), 79.5% were female with a mean age of 43.8 years (±SD 15.02), and 68 enteroscopies were performed with the removal of 64 polypoid lesions. One bleeding episode occurred after operative enteroscopy, and the need for subsequent surgery occurred in six patients with PJ and in five patients with FAP. The surgical indications in PJ patients were the presence of large polyps (three patients) and three cases of intussusception, one of which was a patient with a polyp in the proximal ileum, not reachable with the scope. One patient with PJ died from pancreatic cancer during follow up. The surgical indications in patients with FAP were the presence of four large polyps with high-grade dysplasia and one ampullary neoplasia recurrence.
CONCLUSIONS: In PJ patients, the endoscopic treatment of small bowel polyps was safe. During the follow-up period, the patients with successful endoscopic treatment did not need surgery. In FAP patients treated with DAE, none developed cancer.