Chromoendoscopic Colonoscopy for Detecting Preneoplastic Lesions in Hereditary Nonpolyposis Colorectal Cancer Syndrome

Lecomte, Thierry; Cellier, Christophe; Méatchi, Tchao; Barbier, Jean Philippe; Cugnenc, Paul-Henri; Jian, Raymond; Laurent‐Puig, Pierre; Landi, Bruno

doi:10.1016/s1542-3565(05)00403-9

Cited by 122 publications

(82 citation statements)

References 33 publications

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“…Bei Patienten mit Colitis ulcerosa [458 -462] oder HNPCC [463,464] ist eine höhere Detektionsrate neoplastischer Läsionen durch Chromoendoskopie wahrscheinlich, allerdings ohne bewiesenen Effekt auf den Gesamt-Outcome [462]. Es ist bisher nicht geklärt, ob die Erkennung höherer Raten vorwiegend kleiner Veränderungen dem Patienten nutzen und den erhöhten Zeitaufwand der direkten Chromoendoskopie rechtfertigen.…”

Section: Level Of Evidence 1bunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

148

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Section: Level Of Evidence 1bunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

148

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“…In one study, the use of chromoendoscopy detected an additional 45 lesions in 20 patients compared to conventional colonoscopy alone (16). In a retrospective study of 33 CDH-1 mutation carriers having undergone screening gastroscopies, 41% of chromoendoscopyguided biopsies revealed signet-ring cell carcinoma (in 10 patients) in lesions that would have otherwise been missed by white-light endoscopy (17).…”

Section: Discussionmentioning

confidence: 99%

Low yield of gastroscopy in patients with Lynch syndrome

Galiatsatos¹,

Labos²,

Jeanjean³

et al. 2017

Turk J Gastroenterol

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Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome, accounting for 1%-4% of all CRCs and 10% of CRCs under the age of 50 years (1). It is an autosomal dominant condition caused by germline mutations in one of four DNA mismatchrepair (MMR) genes, namely MLH1, MSH2, MSH6, and PMS2, as well as mutations in the EPCAM gene, which inactivates MSH2 via promoter hypermethylation. Besides a lifetime risk of CRC averaging 70%-80%, there is also an increased risk of extracolonic tumors, including carcinoma of the endometrium (40%-60% lifetime risk), ovary, stomach, small bowel, pancreas, hepatobiliary tree, brain, and urinary tract (2). The Amsterdam II criteria are a clinical tool used to help identify LS mutation carriers (Figure 1).The utility of routine surveillance gastroscopy in LS has been a topic of debate for several years. While gastric cancer (GC) was a predominant feature of LS a century ago, it is much less common now, indicating the significant decline in GC incidence in the Western world over the last few decades (3). Until recently, screening gastroscopies were periodically performed for LS patients followed in the Genetics clinic or Hereditary Gastrointestinal Cancer Clinic (GENGI) of our institution. 2017; 28: 434-8 ABSTRACT Background/Aims: Lynch syndrome (LS) is the most common hereditary colorectal cancer syndrome, caused by germline mutations in mismatch-repair genes. Besides a lifetime risk of colorectal cancer averaging 70%-80%, there is an increased risk of extracolonic tumors including gastric cancer. The utility of screening gastroscopy in Lynch syndrome has long been debated. This study aimed to determine the proportion of abnormal gastroscopies among patients screened, including the incidence of gastric cancer and prevalence of precursor lesions. Materials and Methods: Charts of patients with mutation-proven Lynch syndrome between January 1, 2004, and December 31, 2014, from the Genetics clinic and Hereditary Gastrointestinal Cancer Clinic of our institution were retrospectively reviewed. Turk J GastroenterolResults: A total of 66 Lynch syndrome patients were identified. Thirty-two gastroscopies were performed in 21 (32%) of them. No gastric cancers were found. The prevalence of precursor lesions (Helicobacter pylori gastritis, atrophic gastritis, and gastric intestinal metaplasia) was 19.05%. A family history of gastric cancer was associated with a non-significant increased risk of abnormal gastroscopy, while sex and specific gene involved did not affect the abnormality rate. Conclusion: Gastric screening in asymptomatic individuals with Lynch syndrome is probably best reserved for high-risk individuals, based on the family history and perhaps ethnicity as suggested by several governing bodies. Larger studies are required to achieve the statistical power necessary to address this controversial issue.

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“…Features of Lynch syndromeassociated colorectal cancer that are addressed by these recommendations include early age of cancer onset, accelerated carcinogenesis of adenomas into carcinomas, and predilection to cancer of the proximal colon (about 70% of Lynch syndrome-related colorectal cancers occur in the right colon, which is not accessed through sigmoidoscopy). 4,7 There is continuing research into improvements in colonoscopic detection of polyps and adenomas, such as chromoscopic colonoscopy 33,34 and the use of narrow band imaging. 35 Lindor and colleagues 30 recommend subtotal colectomy for patients with Lynch syndrome who have colorectal cancer, and they also recommend urinalysis with cytology beginning between age 25 and 35.…”

Section: Surveillance and Managementmentioning

confidence: 99%