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UTILITY OF ENDOSCOPIC ISCHEMIC POLYPECTOMY FOR THE TREATMENT OF POLYPS IN THE SMALL INTESTINE OF PEUTZ-JEGHERS SYNDROME

Takashi Taida 1,2, Yuki Ohta 1, Ryosuke Horio 1, Chihiro Goto 1, Akane Kurosugi 1, Michiko Sonoda 1,2, Tatsuya Kaneko 1, Tsubasa Ishikawa 1,2, Keiko Saito 1, Kenichiro Okimoto 1, Tomoaki Matsumura 1, Jun Kato 1,2, Naoya Kato 1

Affiliations

1 Graduate School of Medicine, Chiba University, Chiba, Japan

2 Chiba University Hospital, Chiba, Japan

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Abstract

Introduction

Peutz-Jeghers polyps (PJPs), seen in Peutz-Jeghers syndrome (PJS), are found throughout the gastrointestinal tracts except for the esophagus. Of these, polyps in the small intestine are likely to become numerously developed and enlarged, resulting in intestinal intussusception which requires surgical treatment. Therefore, endoscopic treatment is recommended to prevent intestinal intussusception. Recently, endoscopic ischemic polypectomy (EIP) as the strangulation of the polyps using endoclips without polypectomy has been a treatment option for PJPs of the small intestine as well as conventional endoscopic mucosal resection (EMR). However, there has been insufficient data on the clinical utility and safety of EIP compared to EMR, and that needs to be clarified.

Aims & Methods

The purpose of this study was to evaluate the utility and safety of EIP for PJP in the small intestine. We retrospectively recruited PJS patients who underwent ballon-assisted enteroscopy at Chiba University Hospital between February 2010 and December 2023. The clinical information such as patient clinical backgrounds, treatment option, number of polyps, maximum diameter of polyps, and incidence of bowel obstruction after treatment were analyzed in patients who underwent endoscopic treatment for PJPs of the small intestine. The safety profile per-treatment was evaluated using the inverse probability weighting (IPW) method regarding the incidence of bleeding and intussusception after treatment.

Results

During the research period, 55 enteroscopies were performed, of which 37 (20 EMR and 17 EIP) endoscopic treatments were performed for a total of 239 PJPs (diameter 10-40 mm) in 10 PJS patients. The pathological evaluation was performed for 15 lesions (diameter 15-40 mm) treated with EMR, and all were diagnosed as PJPs. While there was no difference in the total time for endoscopic procedures including insertion and treatment between the EMR and EIP groups (182.5 min vs. 179.1 min, P=0.497), the number of treated polyps at one procedure was significantly higher in the EIP group (3.0±2.1 polyps by EMR v.s. 10.5±13.0 polyps by EIP, P=0.015). Post-treatment complications included bleeding in 5 treatments while no intussusception was observed. IPW analysis revealed that EIP was associated with a significantly lower risk of complications (P=0.017, OR=0.186, 95% CI 0.047-0.738) (Table).

Table. Weighted logistic regression analysis of the risk of bleeding after treatment for PJP.

	OR	95%CI	P value
EIP	0.186	0.047 - 0.738	0.017

Adjusted for gender, age at treatment, presence of intestinal adhesion, scope approach (via-oral or via anal), endoscopist (expert or non-expert), insert length, number of treated polyps, maximum diameter of polyps, and total time as confounding factors.

Conclusion

EIP for PJPs in the small intestine is a safer treatment option for numerous lesions than EMR.

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

SMALL INTESTINAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Best of UEG Week - Oncology

Pradeep Mundre 1, Julia Mayerle 2, Ana-Maria Bucalau 3

Affiliations

1 Bradford Teaching Hospitals NHS trust, Leeds, United Kingdom

2 Klinikum der LMU München-Grosshadern, München, Germany

3 Erasme University Hospital, Belgium

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Abstract

Topics

Digestive Oncology

Published

2023

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Exclusive enteral nutrition: The effect on immunometabolism

Dirk Haller 1

Affiliations

1 Technical University of Munich, Munich, Germany

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Abstract

Event

UEG Week Barcelona 2026

Topics

Small Intestine & Nutrition Mechanisms & Personalised Medicine Immunology IBD

Session

Metabolic aspects of immunomodulatory IBD therapy

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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DISSECTING THE ROLE OF OSM-OSMR AXIS IN INTESTINAL INFLAMMATION AND TISSUE REMODELING

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DISSECTING THE ROLE OF OSM-OSMR AXIS IN INTESTINAL INFLAMMATION AND TISSUE REMODELING

Luis Velasco Blazquez 1,2, Gino Kwon 1,2, Camila Cancino 1,2, Zhenjie Yin 1,2, Yanjiang Luo 1,2, Mariia Saliutina 1,2, Soraya Abu-Sharki 1,2, Ahmed N. Hegazy 1,2

Affiliations

1 Charité Universitätsmedizin Berlin, Department of Gastroenterology, Infectiology and Rheumatology, Berlin, Germany, Berlin, Germany

2 Deutschen Rheuma-Forschungszentrums Berlin (DRFZ), Berlin, Germany

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Abstract

Introduction

Oncostatin M (OSM) tracks with intestinal inflammation and predicts poor treatment response in inflammatory bowel disease (IBD). Chronic inflammation in patients presents with varied histological and molecular features, and repeated tissue injury drives fibrosis and aberrant remodeling. How the OSM-OSMR axis contributes across these different pathological contexts, and whether its role depends on the type of tissue injury and the cellular compartment that responds to OSM, remains poorly understood.

Aims & Methods

We examined the relationship between OSM-associated inflammatory molecular signatures and tissue pathology in human IBD, then tested the functional role of the OSM-OSMR axis in experimental intestinal inflammation. Human intestinal biopsies and surgical resections were stratified by an inflammatory gene module containing OSM into Inflammatory module high and low groups, then compared with healthy controls. We assessed tissue features with PathAI-based digital pathology and spatial transcriptomics, integrated with bulk RNAseq-derived inflammatory profiles. To mimic various type of tissue injury, we used DSS-induced colitis to model epithelial barrier disruption, testing global and cell-specific OSM-OSMR deficient mice across acute and chronic DSS inflammation and fibrosis with histopathological scoring, inflammatory gene signatures and flow cytometry of immune and stromal compartments.

Results

OSM Inflammatory module high patients displayed increased histopathological score, epithelial erosions and ulcerations compared with Inflammatory module low patients, together with increased lamina propria neutrophil infiltration. Spatial analysis highlighted spatial proximity of OSMhi neutrophils to epithelial erosions and ulcerations. Despite these associations, and the protective effect of OSMR depletion previously described, disrupting OSM-OSMR signaling across multiple cellular compartments did not alter histopathological severity in this model of acute epithelial loss. Compartment-dependent phenotypes emerged instead during chronic DSS. Endothelial OSMR deletion altered collagen deposition without affecting histopathological inflammation or colon features after three cycles of DSS. Conversely, OSMR deletion in stromal cells preserved colon length and reduced immune-cell infiltration, suggesting mesenchymal OSMR signaling contributes to chronic intestinal inflammation.

Conclusion

An OSM-associated inflammatory program identifies IBD with severe epithelial damage and increased neutrophil infiltration. OSM-OSMR disruption does not consistently improve acute epithelial injury. In chronic DSS, OSMR signaling in distinct compartments contributes to different features of disease, with endothelial OSMR linked to tissue remodeling and mesenchymal OSMR to immune infiltration. Together, these findings show that the functional consequences of OSM-OSMR signaling depend on pathological features, disease stage and the responding cellular compartment.

References

1. West, N. R., Hegazy, A. N., Owens, B. M., Bullers, S. J., Linggi, B., Buonocore, S., ... & Powrie, F. (2017). Oncostatin M drives intestinal inflammation and predicts response to tumor necrosis factor–neutralizing therapy in patients with inflammatory bowel disease. Nature medicine, 23(5), 579-589.
2. Cineus, R., Luo, Y., Saliutina, M., Manna, S., Cancino, C. A., Velasco Blázquez, L., ... & Hegazy, A. N. (2025). The IL-22–oncostatin M axis promotes intestinal inflammation and tumorigenesis. Nature immunology, 26(6), 837-853.
3. West, N. R., Owens, B. M., & Hegazy, A. N. (2018). The oncostatin M‐stromal cell axis in health and disease. Scandinavian journal of immunology, 88(3), e12694.

Event

UEG Week Barcelona 2026

Topics

Histopathology Surgery Radiology & Imaging Mechanisms & Personalised Medicine Immunology IBD

Submission format

Late-Breaking Abstract

Session

Late-Breaking in IBD: From translational discoveries to treatment

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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European guidelines on microscopic colitis: UEG and European Microscopic Colitis Group (EMCG) statements and recommendations

Iago Rodríguez-Lago 1, Stephan Miehlke 2

Affiliations

1 Hospital Universitario de Galdakao, Bilbao, Spain

2 Eppendorf Center for Digestive Diseases, Hamburg, Germany

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Abstract

Topics

IBD

Published

2021

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Access to care: Is there equity?

Simon Gabe 1

Affiliations

1 St. Mark's Hospital, Harrow, United Kingdom

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Abstract

Event

UEG Week Barcelona 2026

Topics

Primary Care Small Intestine & Nutrition

Session

Short bowel syndrome: Are we making progress?

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Intestinal failure and parenteral nutrition

Shameer Mehta 1

Affiliations

1 UCL, London, United Kingdom

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Abstract

Event

UEG Week Barcelona 2026

Topics

Small Intestine & Nutrition Surgery Neurogastroenterology & Motility

Session

Mistakes in… Upper GI

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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