Chromoscopy and Adenoma Detection in Lynch SyndromeChromoscopy and Adenoma Detection in Lynch Syndrome
Is chromocolonoscopy more effective than standard colonoscopy at detecting adenomas in patients with Lynch syndrome? The American Journal of Gastroenterology
Patients with Lynch syndrome are at high risk for developing colorectal cancer (CRC). Regular colonoscopic surveillance is recommended, but there is no international consensus on the appropriate interval. We investigated whether shorter intervals are associated with lower CRC incidence and detection at earlier stages by comparing the surveillance policies in Germany, which evaluates patients by colonoscopy annually, in the Netherlands (patients evaluated at 1 –2-year intervals), and Finland (patients evaluated at 2–3-year intervals).
We report here a 16-year-old patient who presented initially with symptoms characteristic of appendicitis. Following a CT scan suggesting perforated appendicitis, the patient was treated with intravenous antibiotics with a scheduled interval appendectomy three months later. Pathology reports from the interval appendectomy showed that the specimen contained a well-to-moderately differentiated adenocarcinoma. The patient then underwent robot assisted right hemicolectomy as definitive management, which demonstrated that the tumor originated in the cecum with invasion into the submucosa and focally infiltrating the muscularis ...
Adenoma miss rates in colonoscopy are unacceptably high, especially for sessile serrated adenomas / polyps (SSA/Ps) and in high-risk populations, such as patients with Lynch syndrome. Detection rates may be improved by fluorescence molecular endoscopy (FME), which allows morphological visualization of lesions with high-definition white-light imaging as well as fluorescence-guided identification of lesions with a specific molecular marker. In a clinical proof-of-principal study, we investigated FME for colorectal adenoma detection, using a fluorescently labelled antibody (bevacizumab-800CW) against vascular endothelial grow...
Colonoscopic surveillance with indigo carmine chromoendoscopy (ICC) in Lynch Syndrome (LS) patients improves adenoma detection rate and is widely used nowadays. Nevertheless, it is a time-and money-consuming technique which requires a dedicated training. Narrow band imaging (NBI) is a well-known virtual chromoendoscopy technique that highlights superficial mucosal vessels and improves contrast for adenomas. We conducted a prospective multicenter study in a back-to-back fashion to compare 3rd generation NBI to ICC for detecting colonic adenomas in LS patients.
DEAR MAYO CLINIC: I am considering undergoing genetic testing to see if I have the gene mutation that causes Lynch syndrome. Because of my family history, I already have regular colonoscopies even though I?m only 41. What would knowing I have the mutation change as far as how I?m monitored for colon cancer? ANSWER: Knowing [...]
ConclusionPatients with LS have an increased risk of MC, especially CRCs. With a median time period of 24 months between colonoscopy and metachronous CRC, the interval between surveillance colonoscopies following primary CRC should not exceed 18 months, especially in patients with MSH2 mutation.
AbstractPurposeLynch syndrome (LS) is associated with a high risk of colorectal cancer (CRC). The aim of this study was to assess the cumulative risk for the development of colorectal adenomas or carcinomas in a LS CRC surveillance program and to audit the quality of the endoscopic procedures.MethodsWe evaluated 147 asymptomatic LS mutation carriers, without previous CRC, in a surveillance program with colonoscopy every 12 –18 months, between 2005 and 2016. Data was obtained by retrospective review of colonoscopy reports and hospital clinical files. The main outcome was assessed using Kaplan–Meier curves. ...
Conditions: Lynch Syndrome; Colonoscopy Intervention: Diagnostic Test: Colonoscopy Sponsors: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA); FUJIFILM Europe GmbH Not yet recruiting