Long‐Term Outcomes of Double‐Balloon Enteroscopy Polypectomy for Large Small Bowel Polyps Detected During Surveillance Imaging in Patients With Peutz–Jeghers Syndrome

ABSTRACT Objectives Double‐balloon enteroscopy (DBE) is effective for managing small bowel (SB) diseases. We aimed to evaluate the patient outcomes of DBE polypectomy in Peutz–Jeghers syndrome (PJS) with large SB polyps at surveillance imaging studies and to identify the risk factors for SB surgery. Methods Forty‐five PJS patients who underwent regular SB surveillance imaging studies from 2005 to 2023 were retrospectively included. DBE was performed for polyps > 15 mm detected by imaging studies, and DBE polypectomy was conducted for those > 10 mm or symptomatic ones. Results Patients' average age at PJS diagnosis and surveillance initiation was 19.9 and 27.8 years, respectively. Thirty‐one (68.9%) patients had laparotomy before surveillance. Each patient underwent 2.7 DBE procedures at a 31.0‐month interval. An average of 7.8 and 4.4 polyps were removed during the first and second DBE procedures ( p = 0.070). During 9 (8.2%) DBE procedures, complications, including two perforations requiring surgery, occurred. During the follow‐up period, 11 patients required SB surgery, with a median time to surgery of 155 months. Patients with ≥ 5 polyps removed at initial DBE had a higher cumulative probability of SB surgery than those with < 5 polyps (hazard ratio [HR] 9.65, p = 0.031). Patients with ≥ 3 laparotomies before surveillance tended to have an increased surgery risk (HR 9.98, p = 0.078). Conclusions DBE polypectomy effectively manages large SB polyps detected by imaging surveillance in PJS over the long term. Early initiation of surveillance should be emphasized to minimize the risk of SB surgery.