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Detection of bowel polyps in hereditary polyposis syndromes

Capsule endoscopy may be of clinical value in selected patients with familial adenomatous polyposis, whereas in Peutz-Jeghers syndrome, capsule endoscopy could be used as first line surveillance procedure, reports January's American Journal of Gastroenterology.

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At present, surveillance of premalignant small bowel polyps in hereditary polyposis syndromes has a number of limitations.

Capsule endoscopy (CE) is a promising new method to endoscopically assess the entire length of the small bowel.

Dr Hollerbach and colleagues from Germany prospectively examined 40 patients with hereditary polyposis syndromes (29 familial adenomatous polyposis (FAP), 11 Peutz-Jeghers syndrome (PJS)).

The research team compared these results with push-enteroscopy (PE) results in FAP and with esophagogastroduodenoscopy, PE, (MR)-enteroclysis, and surgical specimen in PJS patients.

Capsule endoscopy detected polyps in 10 of 11 patients with Peutz-Jeghers syndrome
The American Journal of Gastroenterology

The researchers found that a total of 76% of the patients with FAP with duodenal adenomas had additional adenomas in the proximal jejunum that could be detected by capsule endoscopy and push-enteroscopy.

Moreover, the research team noted that 24% of these FAP patients had further polyps in the distal jejunum or ileum that could only be detected by capsule endoscopy.

In contrast, the researchers found that in FAP patients without duodenal polyps, jejunal or ileal polyps occurred rarely (12%).

Capsule endoscopy detected polyps in 10 of 11 patients with PJS, a rate superior to all other reference procedures employed.

Importantly, the team noted that the findings of capsule endoscopy had immediate impact on further clinical management in all PJS patients.

The team concluded, "Our results suggest that CE may be of clinical value in selected patients with FAP, whereas in PJS, CE could be used as first line surveillance procedure."

The American Journal of Gastroenterology; 2005: 100 (1), 27-37
17 January 2005

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