PURPOSE: Juvenile polyposis syndrome is characterized by multiple hamartomatous polyps in the large intestine. When indicated, the surgical choices in symptomatic juvenile polyposis syndrome patients are colectomy wit...PURPOSE: Juvenile polyposis syndrome is characterized by multiple hamartomatous polyps in the large intestine. When indicated, the surgical choices in symptomatic juvenile polyposis syndrome patients are colectomy with ileorectal anastomosis or proctocolectomy with pouch. The aim of this study was to evaluate the long-term outcomes of the surgical options in juvenile polyposis syndrome patients who present with symptomatic colonic polyps. METHODS: The charts of all juvenile polyposis syndrome patients who had had at least one colonic operation since 1953 in our institution were reviewed. The following data were abstracted: demographics, the number and site of the polyps, symptoms, the intervals and types of the colonic operation, follow-up, and the patients’current status. RESULTS: There were 13 patients (6 males) with a median age of 10 years (range, 1-50 years) at the time of diagnosis. Patients had colonic (n = 13), rectal (n = 12), and gastric (n = 6) polyps. Rectal bleeding (n = 11) was the most common presenting symptom. Three patients underwent proctectomy as the initial operation. Although a rectum-preserving operation was initially performed in ten patients, a subsequent proctectomy was required in five of them within a median of 9 years (range, 6-34 years). Therefore, eight patients had their rectum removed during the study period; five had an ileal pouch-anal anastomosis, one had a Koch pouch as a restorative surgery, and two had an end ileostomy. No relation was observed between the number of colonic and rectal polyps and the type of surgery or the need for proctectomy. Patients were followed up a median of 3 years (range, 2-24 years) after their ultimate operations. During this period, one patient (20 percent) who underwent restorative proctectomy and 4 patients (80 percent)-whose rectums were preserved required multiple endoscopic polypectomies for recurrent polyps in the pouch (first patient)-or their rectums (the other four patients). The patient who underwent the Koch procedure required surgery for recurrent polyps in her pouch. CONCLUSIONS: One-half of the patients who initially underwent rectal preservation required subsequent proctectomy. The number of colonic or rectal polyps does not influence the choice of the surgical procedure. Both restorative proctocolectomy and subtotal colectomy with ileorectal anastomosis need endoscopic follow-up because of the high recurrence rates of juvenile polyps in the remnant rectum or pouch.展开更多
Background and Study Aims: The small bowel is anatomically difficult to examin e; disease conditions are rarely located in it, but can be serious. Neither conv entional radiography nor push enteroscopy has sufficient ...Background and Study Aims: The small bowel is anatomically difficult to examin e; disease conditions are rarely located in it, but can be serious. Neither conv entional radiography nor push enteroscopy has sufficient sensitivity and specifi city to detect distinct lesions. Wireless capsule endoscopy can theoretically al low imaging of the entire small bowel, with only minimal discomfort for the pati ent. Patients and Methods: Between November 2001 and May 2003, 191 patients rece ived 195 capsules. Data were collected retrospectively from consecutive patients in three centers. The indications for capsule endoscopy were obscure or occult bleeding, suspected Crohn’s disease, or other reasons in 151, 25, and 15 patien ts, respectively. The clinical outcome after 6 months was evaluated on the basis of interviews with patients or relatives. Results: Visualization of the entire small bowel was adequate in 78.4%of the examinations. The colon was not reached in 16.9%of cases, and there were minor technical problems in 4.6%. Relevant p athological findings were identified in 56.2%of 151 patients with obscure bleed ing or iron-deficiency anemia (64%of whom received blood transfusions). The mo st common findings were angiodysplasia in 39.7%of cases and ulcers of the small bowel in 7.3%. In addition, individual cases of tumors and parasitic worms wer e detected. Seven of the 25 patients with suspected Crohn’s disease (28%) had the disease confirmed. Three of five patients with polyposis syndrome of the col on were found to have polyps in the small bowel. Conclusions: Wireless capsule e ndoscopy can be recommended as part of the routine work-up in patients with obs cure bleeding or iron-deficiency anemia. In patients with Crohn’s disease, the method may be helpful in establishing or ruling out the diagnosis.展开更多
文摘PURPOSE: Juvenile polyposis syndrome is characterized by multiple hamartomatous polyps in the large intestine. When indicated, the surgical choices in symptomatic juvenile polyposis syndrome patients are colectomy with ileorectal anastomosis or proctocolectomy with pouch. The aim of this study was to evaluate the long-term outcomes of the surgical options in juvenile polyposis syndrome patients who present with symptomatic colonic polyps. METHODS: The charts of all juvenile polyposis syndrome patients who had had at least one colonic operation since 1953 in our institution were reviewed. The following data were abstracted: demographics, the number and site of the polyps, symptoms, the intervals and types of the colonic operation, follow-up, and the patients’current status. RESULTS: There were 13 patients (6 males) with a median age of 10 years (range, 1-50 years) at the time of diagnosis. Patients had colonic (n = 13), rectal (n = 12), and gastric (n = 6) polyps. Rectal bleeding (n = 11) was the most common presenting symptom. Three patients underwent proctectomy as the initial operation. Although a rectum-preserving operation was initially performed in ten patients, a subsequent proctectomy was required in five of them within a median of 9 years (range, 6-34 years). Therefore, eight patients had their rectum removed during the study period; five had an ileal pouch-anal anastomosis, one had a Koch pouch as a restorative surgery, and two had an end ileostomy. No relation was observed between the number of colonic and rectal polyps and the type of surgery or the need for proctectomy. Patients were followed up a median of 3 years (range, 2-24 years) after their ultimate operations. During this period, one patient (20 percent) who underwent restorative proctectomy and 4 patients (80 percent)-whose rectums were preserved required multiple endoscopic polypectomies for recurrent polyps in the pouch (first patient)-or their rectums (the other four patients). The patient who underwent the Koch procedure required surgery for recurrent polyps in her pouch. CONCLUSIONS: One-half of the patients who initially underwent rectal preservation required subsequent proctectomy. The number of colonic or rectal polyps does not influence the choice of the surgical procedure. Both restorative proctocolectomy and subtotal colectomy with ileorectal anastomosis need endoscopic follow-up because of the high recurrence rates of juvenile polyps in the remnant rectum or pouch.
文摘Background and Study Aims: The small bowel is anatomically difficult to examin e; disease conditions are rarely located in it, but can be serious. Neither conv entional radiography nor push enteroscopy has sufficient sensitivity and specifi city to detect distinct lesions. Wireless capsule endoscopy can theoretically al low imaging of the entire small bowel, with only minimal discomfort for the pati ent. Patients and Methods: Between November 2001 and May 2003, 191 patients rece ived 195 capsules. Data were collected retrospectively from consecutive patients in three centers. The indications for capsule endoscopy were obscure or occult bleeding, suspected Crohn’s disease, or other reasons in 151, 25, and 15 patien ts, respectively. The clinical outcome after 6 months was evaluated on the basis of interviews with patients or relatives. Results: Visualization of the entire small bowel was adequate in 78.4%of the examinations. The colon was not reached in 16.9%of cases, and there were minor technical problems in 4.6%. Relevant p athological findings were identified in 56.2%of 151 patients with obscure bleed ing or iron-deficiency anemia (64%of whom received blood transfusions). The mo st common findings were angiodysplasia in 39.7%of cases and ulcers of the small bowel in 7.3%. In addition, individual cases of tumors and parasitic worms wer e detected. Seven of the 25 patients with suspected Crohn’s disease (28%) had the disease confirmed. Three of five patients with polyposis syndrome of the col on were found to have polyps in the small bowel. Conclusions: Wireless capsule e ndoscopy can be recommended as part of the routine work-up in patients with obs cure bleeding or iron-deficiency anemia. In patients with Crohn’s disease, the method may be helpful in establishing or ruling out the diagnosis.
