Utility, Performance and Safety of Single Balloon Enteroscopy in Patients with Hereditary Polyposis Syndromes

Abstract

Background and Aims: Patients with hereditary polyposis syndromes are at high risk of developing small bowel polyps. We aimed to investigate the effectiveness of single balloon enteroscopy (SBE) in detecting and removing such polyps and to compare its diagnostic yield to videocapsule endoscopy (VCE).

Methods: We retrospectively recruited patients undergoing SBE and VCE in our center for familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome (PJS), Cowden syndrome (CS) and juvenile polyposis syndrome (JPS). K Cohen concordance index and sensitivity, specificity, positive/negative predictive value (PPV-NPV) and odds ratio (OR) were calculated.

Results: We recruited 17 patients (9 females, 8 males, age range 29-82), undergoing 35 SBE procedures (7 JPS, 2 LS, 7 PJS, 4 CS, 15 FAP). Small bowel polyps were found in 19 cases (54%), in 6 JPS, 4 PJS, 2 CS and 7 FAP, with size ranging 3 mm-3 cm. The risk of small bowel polyps was not linked to the presence of gastric (OR=1.12, p=1), nor duodenal polyps (OR=0.89, p=1). Compared to VCE, the k index was 0.33±0.16, with sensitivity 79%, specificity 53%, PPV=68%, NPV=67%. Agreement was higher for polyps >1 cm (k=0.53) than for small ones (k =0.35). Thirteen polypectomy sessions were performed in polyps >1 cm, removing median 3 polyps/session (range 1-6). We observed only one early bleeding, treated with clips, and two cases of post-procedural abdominal pain.
Conclusions: Small bowel polyps may be commonly found in the polyposis syndrome. Concordance VCE-SBE is only fair. Polypectomy may be easily performed during SBE, with a low complication rate.