Risk for Surgery in Patients with Polyposis Syndrome after Therapy by Device-Assisted Enteroscopy (DAE): Long-Term Follow Up

Background and aim of the study: Polyposis syndromes such as Peutz–Jeghers (PJ) and\r\nfamilial adenomatous polyposis (FAP) are associated with the growth of small bowel polyps; the\r\nrisk is approximately 60–90% for PJ and 40–70% for FAP. The primary aim of this study was to\r\nevaluate the efficacy of device-assisted enteroscopy (DAE) in the detection and treatment of small\r\nbowel polyps to reduce the risk of surgery. The secondary objective was to study complications and\r\nmortality. Methods: We conducted a retrospective cohort study by analyzing a structured database.\r\nBetween September 2006 and October 2019, we observed and followed 42 consecutive patients with\r\npolyposis syndromes; they underwent device-assisted enteroscopy and three were excluded from\r\nelective surgery after the exam. The endoscopic exams were performed for diagnostic and therapeutic\r\npurposes. Results: Thirty-nine patients were evaluated with a mean follow up of 6.7 years (±SD 2.7),\r\n79.5% were female with a mean age of 43.8 years (±SD 15.02), and 68 enteroscopies were performed\r\nwith the removal of 64 polypoid lesions. One bleeding episode occurred after operative enteroscopy,\r\nand the need for subsequent surgery occurred in six patients with PJ and in five patients with FAP.\r\nThe surgical indications in PJ patients were the presence of large polyps (three patients) and three\r\ncases of intussusception, one of which was a patient with a polyp in the proximal ileum, not reachable\r\nwith the scope. One patient with PJ died from pancreatic cancer during follow up. The surgical\r\nindications in patients with FAP were the presence of four large polyps with high-grade dysplasia\r\nand one ampullary neoplasia recurrence. Conclusions: In PJ patients, the endoscopic treatment of\r\nsmall bowel polyps was safe. During the follow-up period, the patients with successful endoscopic\r\ntreatment did not need surgery. In FAP patients treated with DAE, none developed cancer.