Endoscopy 2020; 52(S 01): S151-S152
DOI: 10.1055/s-0040-1704466
ESGE Days 2020 ePoster Podium presentations
Thursday, April 23, 2020 11:30 – 12:00 Colon screening and surveillance 1 ePoster Podium 8
© Georg Thieme Verlag KG Stuttgart · New York

LOW DIAGNOSTIC YIELD OF STANDARD DEFINITION SURVEILLANCE COLONOSCOPY FOR PATIENTS WITH LYNCH SYNDROME

NM Farrelly
1   Mater Misericordiae University Hospital, Gastrointestinal Unit, Dublin, Ireland
,
T Ryan
2   Mater Misericordiae University Hospital and University College Dublin, Gastrointestinal Unit, Dublin, Ireland
,
A Keogh
3   Mater Misericordiae University Hospital, Department of Clinical Pathology, Dublin, Ireland
,
J Aird
4   Mater Misericordiae University Hospital and University College Dublin, Department of Clinical Pathology, Dublin, Ireland
,
P MacMathuna
2   Mater Misericordiae University Hospital and University College Dublin, Gastrointestinal Unit, Dublin, Ireland
,
C Lahiff
2   Mater Misericordiae University Hospital and University College Dublin, Gastrointestinal Unit, Dublin, Ireland
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Lynch syndrome (LS) is the most common form of inherited colorectal cancer. Surveillance colonoscopy using high definition (HD) systems is recommended by ESGE guidelines. Our aim was to evaluate historical endoscopic surveillance for LS using standard definition (SD) colonoscopy.

Methods This was a retrospective cohort study of patients with genetically confirmed LS. Using our prospectively maintained family cancer database, we identified patients who had undergone surveillance colonoscopy over a five-year period. Significant lesions were defined as adenoma or sessile serrated lesions (SSL) of any size and were reviewed by a specialist GI pathologist.

Results Eighty-three patients underwent surveillance colonoscopy at our hospital within the study period. Median age was 44 (range 28-69) and 42% were male. Caecal intubation and rectal retroflexion rates were 100%. Bowel preparation was excellent or adequate in 90%. Mean withdrawal time was 11.6 minutes. Anti-spasmodics were used in 7%. Twenty-seven polyps were identified in 15 patients. All polyps were diminutive (n=7) or small (n=20). Twenty-six polyps were removed by cold forceps (n=17, 65%), cold snare (n=8, 31%) and snare diathermy (n=1, 4%). Five polyps were low-grade adenomas (19%), 4 (16%) were SSLs with (n=2) and without dysplasia, 13 were hyperplastic (50%). Median age of patients with adenoma or SSLs detected was 51.9 years. Adenoma or SSLs were detected more frequently in MLH1 and MSH2 than other genotypes but this was not statistically significant (12% vs. 6%, p=0.67). No patients developed colorectal cancer during the period of follow-up. Narrow-band imaging was used in 11% while no procedures used dye-based chromoendoscopy.

Conclusions Historical diagnostic yields for surveillance using SD colonoscopy in LS are low. Adoption of advanced endoscopic imaging techniques may improve lesion characterisation and dysplasia yields. Larger multicentre prospective studies are required to determine whether this has an impact upon cancer diagnoses and mortality.