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 22 May 2018

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Capsule endoscopy small bowel surveillance for polyposis

This month's issue of the American Journal of Gastroenterology shows that capsule endoscopy should replace radiographic small intestinal surveillance for Peutz-Jeghers syndrome patients, and is safe in polyposis patients who have undergone major intestinal surgery.

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Small intestinal surveillance is recommended for polyposis patients.

The utility and safety of capsule endoscopy for surveillance of small intestinal neoplasia in patients with familial adenomatous polyposis and Peutz-Jeghers syndrome is unknown.

Dr Carol Burke and colleagues offered capsule endoscopy to patients with consecutive familial adenomatous polyposis.

The investigators also offered capsule endoscopy to Peutz-Jeghers syndrome patients due for routine upper endoscopic surveillance.

9 of the 15 subjects with familial adenomatous polyposis had small intestinal polyps
American Journal of Gastroenterology

The investigative team assessed the prevalence, location, size, and numbers of polyps detected by capsule endoscopy.

The investigators included 19 subjects, of which 15 had familial adenomatous polyposis and 4 had Peutz-Jeghers syndrome with a mean age of 43 years.

All subjects had previous intestinal surgery, and no complications occurred with capsule endoscopy in familial adenomatous polyposis.

The team reported that 9 of the 15 subjects with familial adenomatous polyposis had small intestinal polyps.

The investigators found that the prevalence of small intestinal polyps was related to the duodenal polyposis stage and subject age.

The location, size and number of polyps progressed as duodenal polyposis stage advanced.

The investigative team noted that 3 of the 4 subjects with Peutz-Jeghers syndrome had small intestinal polyps.

The team noted that within this patient group, the polyps were diffuse in 2 of the 4 patients and only in the ileum in 1 subject.

Capsule endoscopy findings led to laparotomy with intra-operative endoscopic polypectomy in 2 Peutz-Jeghers syndrome patients.

Dr Burke's team concludes, “Small intestinal polyps are common in familial adenomatous polyposis but their importance is unknown.”

“Capsule endoscopy should be performed in familial adenomatous polyposis patients with stage III and IV duodenal disease.”

“Clinically significant polyps are commonly detected by capsule endoscopy in Peutz-Jeghers syndrome and lead to change in management in 50% of Peutz-Jeghers syndrome subjects.”

“Capsule endoscopy should replace radiographic small intestinal surveillance for Peutz-Jeghers syndrome patients and is safe in polyposis patients who have undergone major intestinal surgery.”

Am J Gastroenterol 2005: 100(7): 1498
12 July 2005

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