A 38−year−old woman with Peutz−Jeghers syndrome was admitted due to a 2−week history of intermittent abdominal pain

syndrome was admitted due to a 2−week history of intermittent abdominal pain and symptoms of incomplete intestinal obstruction. She had experienced symp− toms of incomplete intestinal obstruction 2 years previously, and had undergone explorative laparotomy, which revealed a large polyp of the jejunum that required resection. On admission, laboratory re− sults of the patient were unremarkable. Physical examination revealed a mild dis− tension of the upper abdominal quad− rants. Abdominal radiograph gave no hint of bowel obstruction. Double−balloon enteroscopy via the oral route was carried out, and revealed a polyp at approximately 150 cm distant from the pylorus, which nearly com− pletely occluded the intestinal lumen (l" Figure 1). Using guided double−bal− loon enteroscopy, the polyp was captured with a snare and resected by electric cau− tery. Resection and salvage of the polyp in one piece was achieved (l" Figure 2). No subsequent complications occurred. His− tology showed a hamartoma with adeno− matous components. Further examina− tion of the remaining small bowel was refused by the patient. The patient was discharged in good health 1 day after the intervention. No intestinal symptoms reappeared in the following 12 months. Peutz−Jeghers syndrome is characterized by multiple gastrointestinal hamartoma− tous polyps [1]. Peutz−Jeghers polyps have an increased risk of developing ma− lignancy and they bear the risk of compli− cations, such as intestinal hemorrhage or intestinal obstruction. As localization of symptomatic polyps in the small bowel prevents access by conventional gastroin− testinal endoscopy, the majority of com− parable cases have required surgical treatment [2]. Technical advances in endoscopy of the small bowel have been achieved by the invention of push−enteroscopy; never− theless its range is limited [3]. Capsule endoscopy provides images from the whole small intestine [4], but lacks the ability to include therapeutic interven− tions, and moreover bears the potential complication of capsule impaction [5]. The recent invention of double−balloon enteroscopy [6] has improved greatly the ability to image the small intestine; moreover it enables endoscopically di− rected therapy to be carried out. In the present clinically subacute setting, recurrence of a symptomatic Peutz−Je− ghers polyp was likely. In order to avoid surgical re−intervention, double−balloon enteroscopy was carried out as a first− line diagnostic procedure. This proved to be a successful minimally invasive diag− nostic and therapeutic method, accurate− ly visualizing the polyp and allowing ef− fective, definitive, and safe therapy by po− lypectomy. This report points out the beneficial role of double−balloon enteros− copy in Peutz−Jeghers syndrome with symptomatic polyps of the small intes− tine, potentially obviating the need for surgical intervention.