Hazem Hammad, MD, and colleagues from the University of Missouri Hospital and Clinics in Columbia, Missouri, USA present this video case titled “Laparoscopic and hand assisted deep enteroscopy with polypectomy in Peutz-Jeghers syndrome.”

This was a very unique case of a late initial diagnosis of a Peutz-Jeghers syndrome (PJS) patient (at 64 years old) and hence the patient had numerous large sessile and pedunculated polyps throughout the mid small bowel, most of which could not be reached using antegrade and retrograde single and double-balloon enteroscopy. The next step in management is usually performing intra-operative enteroscopy. In this case, we started with laparoscopic assisted peroral enteroscopy. We were unable to reach the previously placed distal tattoo using this technique and we elected to place a hand port, through which the surgeon inserted his hand and helped pleat the bowel over the scope. The distal tattoo was reached and polypectomy of all small bowel polyps (clean bowel sweep) was performed during withdrawal of the scope.

This is a video demonstration of complex endoscopic management of a very unique case that I believe would be helpful to my practicing colleagues if they encounter a similar – often very challenging – case. In this video report, we were the first group to report the use of hand assisted enteroscopy for management of polyps in PJS. This is a novel approach that helped avoid the need for a large open laparotomy incision.

This would definitely be a video an endoscopist or surgeon with limited experience in intra-operative enteroscopy would want to watch as it clearly demonstrates the steps for this complex procedure. We also believe that the use of hand assisted enteroscopy should be attempted as shown in this video to avoid large open laparotomy incisions.

Watch the video here.

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