Intraluminal removal of hamartoma polyps of the gastrointestinal tract in children

Background. Peutz-Jeghers syndrome and juvenile polyposis lead to the formation of hamartoma polyps in the small intestine, which are the cause of anvagination of the small intestine, gastrointestinal bleeding and obstruction of the gastrointestinal tract. Polyps form throughout life and most patients undergo multiple surgeries.

Aim. To determine the effectiveness and safety of balloon enteroscopy (BE) as a method of intraluminal minimally invasive method for removing hamartoma polyps of the deep sections of the small intestine in children with Peutz-Jeghers syndrome and juvenile polyposis.

Materials and methods. The study was performed on the basis of the Endoscopic Research Department of the National Medical Research Center for Children’s Health. In the period from 2013 to 2022, 40 patients were hospitalized: 32 (80%) with Peutz-Jeghers syndrome and 8 (20%) with juvenile polyposis. During the observation period, 78 diagnostic and therapeutic balloon enteroscopies were performed: 70 (89%) antegrade, 8 (11%) retrograde.

Results. A total of 309 polyps of the small intestine were detected during BE: with antegrade BE – 283 (91.5%, mean – 4.1±2.59), with retrograde BE – 27 (8.5%, mean – 3, 48±3.39). A total of 129 polyps of the small intestine were removed: 119 (92.2%) during antegrade BE and 10 (7.8%) during retrograde BE. For BE, detection of clinically significant polyps is predicted with a sensitivity of 90.1% and a specificity of 81.7%. In the postoperative period, 6 complications (7.89%) were revealed. In three cases, a control ultrasound of the abdominal organs revealed small intestinal intussusceptum, so the clinical effect was not achieved: retrograde BE – n=2 (2.62%), antegrade BE – n=1 (1.31%), in two of patients, perforation of the small intestine was detected – retrograde BE – n=1 (1.31%); antegrade BE – n=1 (1.31%) and one patient had bleeding during BE – antegrade BE – n=1 (1.31%).

Conclusion. BE is an effective and safe method of intraluminal minimally invasive removal of small intestinal polyps.