Quality of Colonoscopy Is Associated With Adenoma Detection and Postcolonoscopy Colorectal Cancer Prevention in Lynch Syndrome

Sánchez, Ariadna; Roos, Victorine H.; Navarro, Matilde; Pineda, Marta; Caballol, Berta; Moreno, Lorena; Carballal, Sabela; Rodríguez‐Alonso, Lorena; Cajal, Teresa Ramón y; Llort, Gemma; Piñol, Virgı́nia; López‐Fernández, Adrià; Salces, Inmaculada; Picó, María Dolores; Rivas, Laura; Bujanda, Luís; Garzon, Marta; Pizarro, Ángeles; Castro, Eva Martínez de; López-Arias, Maria Jesus; Povés, Carmen; Garau, Catalina; Rodríguez‐Alcalde, Daniel; Herráiz, Maite; Alvarez-Urrutia, Cristina; Dacal, Andrés; Carrillo-Palau, Marta; Cid, Lucía; Ponce, Marta; Barreiro-Alonso, Eva; Saperas, Esteban; Aguirre, Elena; Romero, Cristina; Bastiaansen, Barbara A.; González‐Acosta, Maribel; Morales‐Romero, Blai; Ocaña, Teresa; Rivero‐Sánchez, Liseth; Jung, Gerhard; Bessa, Xavier; Cubiella, Joaquín; Jover, Rodrigo; Rodríguez-Moranta, Francisco; Balmañà, Judith; Brunet, Joan; Castells, Antoni; Dekker, Evelien; Capellà, Gabriel; Serra-Burriel, Miquel; Moreira, Letícia; Pellisé, María; Balaguer, Francesc

doi:10.1016/j.cgh.2020.11.002

Cited by 26 publications

(36 citation statements)

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“… 29 However, it was shown that a high quality colonoscopy is associated with an increased adenoma detection. 29–31 Besides, an inverse association between colonoscopy quality and the risk of post colonoscopy CRC (PCCRC) in the subsequent colonoscopy was found. 29–31 29 Therefore, since LCI is a non-invasive way to improve adenoma detection without additional costs, these technique might be clinically relevant for these high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…27 28 In patients with Lynch syndrome, with a 7.9% 10 year cumulative incidence of PCCRC, this association was not directly proven. 29 However, it was shown that a high quality colonoscopy is associated with an increased adenoma detection. [29][30][31] Besides, an inverse association between colonoscopy quality and the risk of post colonoscopy CRC (PCCRC) in the subsequent colonoscopy was found.…”

Section: Endoscopymentioning

confidence: 99%

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Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Houwen

Hazewinkel

Pellisé

et al. 2021

Gut

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ObjectiveDespite regular colonoscopy surveillance, colorectal cancers still occur in patients with Lynch syndrome. Thus, detection of all relevant precancerous lesions remains very important. The present study investigates Linked Colour imaging (LCI), an image-enhancing technique, as compared with high-definition white light endoscopy (HD-WLE) for the detection of polyps in this patient group.DesignThis prospective, randomised controlled trial was performed by 22 experienced endoscopists from eight centres in six countries. Consecutive Lynch syndrome patients ≥18 years undergoing surveillance colonoscopy were randomised (1:1) and stratified by centre for inspection with either LCI or HD-WLE. Primary outcome was the polyp detection rate (PDR).ResultsBetween January 2018 and March 2020, 357 patients were randomised and 332 patients analysed (160 LCI, 172 HD-WLE; 6 excluded due to incomplete colonoscopies and 19 due to insufficient bowel cleanliness). No significant difference was observed in PDR with LCI (44.4%; 95% CI 36.5% to 52.4%) compared with HD-WLE (36.0%; 95% CI 28.9% to 43.7%) (p=0.12). Of the secondary outcome parameters, more adenomas were found on a patient (adenoma detection rate 36.3%; vs 25.6%; p=0.04) and a colonoscopy basis (mean adenomas per colonoscopy 0.65 vs 0.42; p=0.04). The median withdrawal time was not statistically different between LCI and HD-WLE (12 vs 11 min; p=0.16).ConclusionLCI did not improve the PDR compared with HD-WLE in patients with Lynch syndrome undergoing surveillance. The relevance of findings more adenomas by LCI has to be examined further.Trial registration numberNCT03344289.

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Section: Discussionmentioning

confidence: 99%

Section: Endoscopymentioning

confidence: 99%

Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Houwen

Hazewinkel

Pellisé

et al. 2021

Gut

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“…Despite adherence to appropriate, good-quality endoscopic surveillance, there are still high rates of interval CRC in LS21–23 (figure 4). This population may have distinct carcinogenesis pathways, often without a well-defined polyp stage, with a high prevalence of proximal neoplasia with flat morphology.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and management of Lynch syndrome

Edwards

Monahan

2022

Frontline Gastroenterol

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Lynch syndrome (LS) is a dominantly inherited cancer susceptibility syndrome defined by presence of pathogenic variants in DNA mismatch repair genes MLH1, MSH2, MSH6 and PMS2, or in deletions of the EPCAM gene. Although LS is present in about 1 in 400 people in the UK, it estimated that only 5% of people with this condition are aware of the diagnosis. Therefore, testing for LS in all new diagnoses of colorectal or endometrial cancers is now recommended in the UK, and gastroenterologists can offer ‘mainstreamed’ genetic testing for LS to patients with cancer. Because LS results in a high lifetime risk of colorectal, endometrial, gastric, ovarian, hepatobiliary, brain and other cancers, the lifelong care of affected individuals and their families requires a coordinated multidisciplinary approach. Interventions such as high-quality 2-yearly colonoscopy, prophylactic gynaecological surgery, and aspirin are proven to prevent and facilitate early diagnosis and prevention of cancers in this population, and improve patient outcomes. Recently, an appreciation of the mechanism of carcinogenesis in LS-associated cancers has contributed to the development of novel therapeutic and diagnostic approaches, with a gene-specific approach to disease management, with potential cancer-preventing vaccines in development. An adaptive approach to surgical or oncological management of LS-related cancers may be considered, including an important role for novel checkpoint inhibitor immunotherapy in locally advanced or metastatic disease. Therefore, a personalised approach to lifelong gene-specific management for people with LS provides many opportunities for cancer prevention and treatment which we outline in this review.

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“…MSI can occur spontaneously in 10-15% of colorectal and up to 25 to 35% of endometrial cancers, mainly due to somatic inactivation of the MMR genes by either biallelic hypermethylation of the MLH-1 promoter or by double somatic mutations in one of the MMR system genes. Remarkably, tumors in the context of Lynch syndrome (LS, formerly known as hereditary nonpolyposis colorectal cancer, HNPCC), the most common inherited cancer syndrome, are characterized by MMRd [83][84][85]. LS is caused by monoallelic germline mutations in one of the MMR genes (MLH1, MSH2, MSH6, and PMS2), which predisposes this population to a high risk of developing MSI-H cancers-mainly CRC (accumulated risk of 40-80%) and endometrial cancer (40-60%), usually at young ages [86].…”

Section: Tumor Specific Antigens and Neoantigensmentioning

confidence: 99%

Vaccines for Non-Viral Cancer Prevention

Bayó

Jung

Español-Rego

et al. 2021

IJMS

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Cancer vaccines are a type of immune therapy that seeks to modulate the host’s immune system to induce durable and protective immune responses against cancer-related antigens. The little clinical success of therapeutic cancer vaccines is generally attributed to the immunosuppressive tumor microenvironment at late-stage diseases. The administration of cancer-preventive vaccination at early stages, such as pre-malignant lesions or even in healthy individuals at high cancer risk could increase clinical efficacy by potentiating immune surveillance and pre-existing specific immune responses, thus eliminating de novo appearing lesions or maintaining equilibrium. Indeed, research focus has begun to shift to these approaches and some of them are yielding encouraging outcomes.

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Quality of Colonoscopy Is Associated With Adenoma Detection and Postcolonoscopy Colorectal Cancer Prevention in Lynch Syndrome

Cited by 26 publications

References 23 publications

Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Linked Colour imaging for the detection of polyps in patients with Lynch syndrome: a multicentre, parallel randomised controlled trial

Diagnosis and management of Lynch syndrome

Vaccines for Non-Viral Cancer Prevention

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