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Introduction Peutz-Jeghers syndrome (PJS) is an autosomal dominant polyposis syndrome with predisposition to hamartomatous polyps in the small bowel and emergent risk of intussusception, obstruction and intestinal surgery. We examined outcomes of device-assisted enteroscopy (DAE) at two UK centres: the Royal Hallamshire Hospital, Sheffield and the Royal Free Hospital, London.Methods Patients undergoing DAE for PJS polypectomy between 1st January 2010 and 31st December 2025 were included. Data on the number and maximum size of polyps, polypectomy method, complications, and rate of small bowel (SB) resection before and after DAE was collected by retrospectively reviewing electronic patient records.Results Twenty-four patients underwent 90 DAEs (88 double-balloon enteroscopies [DBEs], 1 laparoscopy-assisted enteroscopy and 1 intra-operative enteroscopy) between 2010 and 2025. There was a mean of 3.8 procedures per patient during a mean observation time of 39 months (range 0-149). 41% (n=10) had a history of SB resection. 19% (n=17) had abdominal pain or intussception on imaging prior to DAE. A total of 229 polyps were removed with a maximum polyp size of 60mm (range 10-60) and a mean of 2.5 polypectomies per procedure. Patients with symptoms and/or intussusception had a larger maximum polyp size than asymptomatic patients (30mm vs 20mm, p=0.02). Polyps were removed by endoscopic mucosal resection (EMR) (n=185), ischaemic clips (n=21), ischaemic endoloop (n=19) or cold snare (n=4). The overall complication rate was 6.7% (n=6). Four complications were related to DBE (pancreatitis [n=2], serositis [n=1] and aspiration pneumonitis [n=1]). One episode of clinically significant post-procedural bleeding followed DBE polypectomy with EMR. There were no complications related to ischaemic polypectomy. One patient undergoing laparoscopy-assisted enteroscopy for a large intusscepting ileal polyp had a post-polypectomy SB perforation repaired laparoscopically but required re-intervention with laparoscopic right hemicolectomy. 4.2% [n=1] required elective SB resection due to failure to reach the polyp via DBE. Complication rate was not significantly associated with procedure length (OR 1.03, 95% CI 1.00-1.06, p=0.06) and was significantly higher than a cohort of DBE procedures for non-polypectomy indications (2.44%, 45/2005) from the UK national audit (p=0.02).Conclusions DAE is an effective strategy for removing PJS small bowel hamartomas and is anticipated to spare patients repeated surgical intervention (and associated complications) due to obstruction and intussusception. However, there is a higher complication rate than other DAE indications of around 6.7%, which should be considered in the consent process.