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“Peutz-Jeghers Syndrome is an extremely rare genetic disorder with an autosomal dominant inheritance pattern. It is characterized by multiple hamartomatous polyps throughout the GI tract, characteristic skin pigmentation, and increased risk of both GI and extraintestinal malignancies. Disease severity see more can vary depending on the degree of genetic penetrance. Symptoms of hamartomatous GI polyps include intussussception, obstruction, rectal bleeding and acute abdominal pain due to polyp infarction. To reduce the need for repeated surgical interventions, endoscopic polypectomy

for all polyps within reach >1cm is recommended. When laparotomy is indicated, the small bowel should be cleared of as many polyps as possible, however, this can be a challenge, as only larger polyps are easily palpated. We present the case of a father and daughter, both known to have Peutz-Jeghers syndrome. Caspase inhibitor in vivo Both presented with recurrent obstructive symptoms with imaging that confirmed large small bowel polyps. Both father and daughter underwent laparotomy with combined endoscopic and open clearance of small bowel polyps. The operative approach involved laparotomy with upper endoscopy using a colonosocope or enteroscope. Endoscopy was facilitated by feeding the small bowel over the endoscope up to the terminal ileum. As the endoscope was

advanced, numerous polyps of various sizes were encountered. When small polyps were encountered, they were removed by snare polypectomy. When large polyps were encountered, they were marked for excision by open polypectomy. Throughout the procedure, the endoscope was continuously passed through the bowel by laparotomy assistance. In this manner, the endoscope was systematically used to surveil the small bowel by manually telescoping the small bowel over the scope to its maximum length. We found a colonoscope, although bulkier and more difficult to navigate, was better able to reach the terminal ileum than an enteroscope.

Peutz-Jegher’s patients commonly present with complications of small bowel polypsis, and routine endoscopic removal of small bowel polyps >1cm is indicated to prevent the need for repeated CYTH4 surgical interventions. Combined surgical and endoscopic polypectomy is a safe and effective approach to thoroughly clear SB polyps when surgery is indicated, and this combined approach of intensive small bowel surveillance may reduce the incidence of future polyp-related morbidity. “
“Although different techniques have been reported, endoscopic resection of subepithelial tumors remains challenging. In this case series we discribe different approaches focusing on a submucosal tunneling technique. Between October and November 2012, 4 patients recieved endoscopic resection of subepithelial tumors in the upper GI tract.