Abstract
Introduction
Peutz-Jeghers syndrome (PJS) is a familial polyposis syndrome characterized by multiple hamartomatous polyps throughout the gastrointestinal tract. The aim of our study was to retrospectively determine the diagnostic value of MR enterography (MRE), performed in supine and prone position, in the detection of small bowel polyps in PJ patients.
Materials and methods
We retrospectively reviewed MRE examinations of 8 PJS patients who underwent MRE, pushed-double-ballon enteroscopy, laparoscopic endoscopy or surgery, within 3 months. Polietilenglicole was orally administered before the examination. True FISP and HASTE sequences were acquired in supine and prone position; 3D VIBE Gd-enhanced sequences in prone position only.
Results
Concordance between MRE and endoscopy was 72.6% for polyps <15 mm, 93% for polyps >15 mm. In supine and prone position concordance with endoscopy for polyps <15 mm was 63% and 66.8%, respectively. In the detection of smaller polyps the difference between supine position only and supine plus prone position was statistically significant (P < 0.027).
Discussion
MRE performed by combining prone and supine position was accurate in the detection of PJS polyps, with 93% concordance with enteroscopy for larger and more risky polyps. MRE offers a promising and non invasive alternative to capsule endoscopy, suggesting the possibility of an effective yearly surveillance in PJ patients.
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References
Chen HM, Fang JY (2009) Genetics of the hamartomatous polyposis syndromes: a molecular review. Int J Colorectal Dis 24(8):865–874
Gammon A, Jasperson K, Kohlmann W, Burt RW (2009) Hamartomatous polyposis syndromes. Best Pract Res Clin Gastroenterol 23:219–231
Schreibman IR, Baker M, Amos C, McGarrity TJ (2005) The hamartomatous polyposis syndromes: a clinical and molecular review. Am J Gastroenterol 100:476–490
Fraser JD, Briggs SE, St Peter SD, De Petris G, Heppell J (2009) Intussusception in the adult: an unsuspected case of Peutz-Jeghers syndrome with review of the literature. Fam Cancer 8:95–101
Beggs AD, Latchford AR, Vasen HF, et al. (2010) Peutz-Jeghers syndrome: a systematic review and recommendations for management. Gut 59:975–986
Vidal I, Podevin G, Piloquet H, et al. (2009) Follow-up and surgical management of Peutz-Jeghers syndrome in children. J Pediatr Gastroenterol Nutr 48:419–425
Boardman LA, Thibodeau SN, Schaid DJ, et al. (1998) Increased risk for cancer in patients with the Peutz-Jeghers syndrome. Ann Intern Med 128(11):896–899
Spigelman AD, Murday V, Phillips RK (1989) Cancer and the Peutz-Jeghers syndrome. Gut 30(11):1588–1590
Dunlop MG (2002) Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, juvenile polyposis, and Peutz-Jeghers syndrome. Gut 51(Suppl 5):V21–V27
Korman U, Kurugoglu S, Ogut G (2005) Conventional enteroclysis with complementary MR enteroclysis: a combination of small bowel imaging. Abdom Imaging 30:564–575
Masselli G, Casciani E, Pollettini E, et al. (2008) Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease. Eur Radiol 18:438–447
Caspari R, von Falkenhausen M, Krautmacher C, et al. (2004) Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers’ syndrome. Endoscopy 36:1054–1059
Gupta A, Postgate AJ, Burling D, et al. (2010) A prospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jaghers Syndrome. AJR Am J Roentgenol 195(1):108–116
Bruwer A, Bargen JA, Kierland RR (1954) Surface pigmentation and generalized intestinal polyposis (Peutz-Jeghers syndrome). Proc Staff Meet Mayo Clin 29:168e71
Peutz J (1921) Very remarkable case of familial polyposis of mucous membrane of intestinal tract and nasopharynx accompanied by peculiar pigmentation of skin and mucous membrane. Nederl Maandschr Geneesk 10:134–146
Jeghers H, McKusick VA, Katz KH (1949) Generalized intestinal polyposis and melanin spots of the oral mucosa, lips and digits; a syndrome of diagnostic significance. N Engl J Med 241:1031–1036
Kopacova M, Tacheci I, Rejchrt S, Bures J (2009) Peutz-Jeghers syndrome: diagnostic and therapeutic approach. World J Gastroenterol 15(43):5397–5408
Jass JR, Williams CB, Bussey HJ, et al. (1988) Juvenile polyposis: a precancerous condition. Histopathology 13:619–630
Vogel T, Schumacher V, Saleh A, et al. (2000) Extraintestinal polyps in PeutzeJeghers syndrome: presentation of four cases and review of the literature. Deutsche Peutz-Jeghers-Studiengruppe. Int J Colorectal Dis 15:118e23
Hearle N, Schumacher V, Menko FH, et al. (2006) Frequency and spectrum of cancers in the Peutz-Jeghers syndrome. Clin Cancer Res 12:3209–3215
Fry LC, Neumann H, Kuester D, et al. (2009) Small bowel polyps and tumours: endoscopic detection and treatment by double-balloon enteroscopy. Aliment Pharmacol Ther 29(1):135–142. doi:10.1111/j.1365-2036.2008.03864.x
Pennazio M, Rondonotti E, de Franchis R (2008) Capsule endoscopy in neoplastic diseases. World J Gastroenterol 14:5245–5253
Kopácová M, Bures J, Ferko A, Tachecí I, Rejchrt S (2010) Comparison of intraoperative enteroscopy and double-balloon enteroscopy for the diagnosis and treatment of Peutz-Jeghers syndrome. Surg Endosc 24(8):1904–1910
Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, et al. (2004) Assessment of Crohn’s disease activity in the small bowel with MR and conventional enteroclysis: preliminary results. Eur Radiol 14(6):1017–1024
McGarrity TJ, Kulin HE, Zaino RJ (2000) Peutz-Jeghers syndrome. AM J Gastroenterol 95:596–604
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Maccioni, F., Al Ansari, N., Mazzamurro, F. et al. Surveillance of patients affected by Peutz-Jeghers syndrome: diagnostic value of MR enterography in prone and supine position. Abdom Imaging 37, 279–287 (2012). https://doi.org/10.1007/s00261-011-9739-4
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DOI: https://doi.org/10.1007/s00261-011-9739-4