Combined endoscopic and surgical treatment in Peutz-Jeghers syndrome.

A combined endoscopic and surgical treatment in Peutz-Jeghers syndrome is presented. Natural history in Peutz-Jeghers syndrome often leads to multiple and acute laparotomies, resulting in intestinal resections. This may lead to a short bowel syndrome. In order to gain control over the small intestinal polyposis, a combined approach by the gastroenterologist and surgeon is performed. At laparotomy, an endoscope is introduced orally into the small intestine which is then telescoped over it by the surgeon. The small intestine is inspected in retrograde order and existing polyposis is treated by endoscopic or surgical polypectomy, or both, or by minimal intestinal resection. Thus, a "clean small intestine" is created. Data on five patients thus treated are presented. No recurrences were seen after this procedure at a mean follow-up period of 21 months. Combined endoscopic and surgical treatment of Peutz-Jeghers syndrome, together with top and tail endoscopy, results in a "clean intestine" and is supposed to diminish the need for multiple acute laparotomies and, therefore, the risk of a short bowel syndrome. There is also supposed to be an improvement in the quality of life and life expectancy.