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DOI: 10.1055/s-0040-1704031
POST-COLONOSCOPY COLORECTAL CANCER IN LYNCH SYNDROME IS ASSOCIATED WITH QUALITY ISSUES DURING SURVEILLANCE
Publication History
Publication Date:
23 April 2020 (online)
Aims To assess the effect of quality endoscopic factors on the development of PCCRC during surveillance in LS mutation carriers.
Methods Multicenter study with 25 high-risk CRC clinics from Spain and 1 from The Netherlands. Demographic, genetics, cancer history, and surveillance protocols from patients LS carriers of verified pathogenic mutations(n=1,746) have been prospectively collected between 2015- 2019. For the current analysis, we focused on healthy-carriers(HC) defined as carriers without CRC prior or in the index colonoscopy. To assess the effect of colonoscopy on PCCRC incidence we evaluated the report of every surveillance colonoscopy(n=3,284). We compared colonoscopies previous to PCCRC with colonoscopies of carriers without cancer. Quality colonoscopy parameters(completeness, bowel-preparation, scope definition and enhancement techniques), time-intervals and findings from a previous colonoscopy were analyzed. Multivariate logistic-regression was performed to identify CRC risk factors.
Results We included 893 HC, 596(63.7%) female, with a median age of 50.5±14.8 years, a median colonoscopy follow-up of 6.3±4.2 years and 4.8±2.7 colonoscopies. The distribution per gene was: 285(31.9%)MLH1, 316(35.4%)MSH2, 212(23.7%) MSH6 and 80(9%) PMS2 carriers. During surveillance 48(5.4%) PCCRC were diagnosed [17(35.4%) MLH1, 24(50%) MSH2, 6(12.5%) MSH6 and 1(2.1%)PMS2]. The mean age at diagnosis was 51.1±10.6 years, the mean follow-up 5.8±5.5 years, 32(66.7%). When analyzing quality colonoscopy indicators, a previous incomplete colonoscopy and previous colonoscopy performed with standard definition appeared as independent risk factors of PCCRC [OR=6.7(95%CI 1.4-33);p0.018 and OR=5.9(95%CI 1.41-25); p0.015]. Besides, an interval between colonoscopies of more than 36 months, or an advanced adenoma in the previous colonoscopy increased more than 4 times the risk of PCCRC[OR=4.1 (95%IC 1.7-9.8);p0.002 and OR=4.16 (95%CI 1.6-10.6);p0.003].
Conclusions PCCCR incidence is associated with quality issues in LS carriers under surveillance colonoscopy. High quality colonoscopy and appropriate interval (< 36 months) should be strongly advised. Patients with an advanced adenoma may benefit of shorter interval between colonoscopies.