The effect of Blue Methylene Tablets on Adenoma Detection in neoplasia surveillance of people with Lynch Syndrome

Aims Lynch syndrome is a hereditary condition associated with an increased risk of colorectal cancer compared to the general population (66.08% for men and 42.71% for women). Improving adenoma detection rate (ADR) is associated with a reduced risk of interval cancer. Recent studies showed that blue methylene tablets (BMT) significantly improved ADR in the screening population. This preliminary study aims to evaluate whether the addition of BMT to standard colonoscopy preparation increases ADR in the high-risk population of Lynch syndrome patients.

Methods This observational non-randomized study included consecutive people≥18 years with genetic diagnosis of Lynch syndrome. Participants were assigned to two groups: one receiving split preparation with 2 litres of PEG and the other receiving BMT in addition to the same bowel preparation (3 tablets dissolved in 0.5 L of water the night before the procedure, and 2 tablets 5 hours before). All patients with previous colonic resections were excluded. The primary outcome was ADR. The t-test for independent samples and Fisher’s exact test were used for statistical analysis.

Results Thirty-eight patients were enrolled, 17 in BMT and 21 in the control group. Twenty-one (55.3%) patients were female and 17 (44.7%) male, with a mean age of 45.6±11.3 years. The two groups were comparable for sex (p=0.75), age (p=0.72), mutation types (p=0.16) and previous polypectomy history (p=0.20). The polyp detection rate was 5/21 (23.8%) in the control group and 5/17 (29.4%) in the BMT group, p=0.73. The ADR was 2/17 (11.8%) in the BMT and 3/21 (14.2%) in the control group (p=0.94). The average number of adenomas per colonoscopy in the BMT group was 1.8±1.7 compared to 1.5±1.22 in the control group (p=0.76). The average number of polyps per colonoscopy in the BMT group was 2.0±1.7 compared to 2.0±2.0 in the control group (p=1).

Conclusions BMT as add-on to standard colonoscopy preparation did not significantly increase the adenoma detection rate in the high-risk population of patients with Lynch syndrome. Further studies with larger sample sizes may be needed to confirm these findings.

Publication History

Article published online:
27 March 2025