White-Light Endoscopy Is Adequate for Lynch Syndrome Surveillance in a Randomized and Noninferiority Study

Rivero‐Sánchez, Liseth; Arnau‐Collell, Coral; Herrero, Jesús García; Remedios, David; Cubiella, Joaquín; García-Cougil, Marta; Alvarez, Victoria; Albéniz, Eduardo; Calvo, Patricia; Gordillo, Jordi; Puig, Ignasi; López-Vicente, Jorge; Huerta, Alaín; López-Cerón, María; Salces, Inmaculada; Peñas, Beatriz; Parejo, Sofía; Santiago, Enrique Rodríguez de; Herraiz, Maite; Carretero, Cristina; Gimeno–García, Antonio Z.; Saperas, Esteban; Álvarez–Urturi, Cristina; Moreira, Rebeca; Miguel, Cristina Rodríguez de; Ocaña, Teresa; Moreira, Letícia; Carballal, Sabela; Sánchez, Ariadna; Jung, Gerhard; Castells, Antoni; Llach, Josep; Balaguer, Francesc; Pellisé, María

doi:10.1053/j.gastro.2019.09.003

Cited by 30 publications

(28 citation statements)

References 33 publications

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“…Not surprisingly, this 'over'-detection could have artificially decreased the proportion of neoplasia among diminutive rectosigmoid lesions in our study (23%), which is lower than the prevalence found in the average-risk population (30%-52%) [7]. Because the NPV depends on the prevalence of the Several factors might explain the misclassification of these [15] three lesions. Although a strict adherence to NICE and Kudo classifications was not required, endoscopists used them as part of the optical diagnostic process.…”

Section: Accepted Manuscriptcontrasting

confidence: 54%

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The “diagnose and leave in” strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial

et al. 2020

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Background and study aim: The ‘diagnose-and-leave-in’ policy has been established to reduce risks and costs related to unnecessary polypectomies in the average-risk population. In Lynch syndrome individuals, due to accelerated carcinogenesis, the general recommendation is to remove all polyps, irrespective of size, location and appearance. We evaluated the feasibility and safety of the ‘diagnose-and-leave-in’ strategy in Lynch syndrome individuals. Patients and methods: We performed a post-hoc analysis based on per-polyp data from a randomized, clinical trial conducted by 24 dedicated colonoscopists at 14 academic centres, in which 256 individuals with confirmed Lynch syndrome underwent surveillance colonoscopy from July 2016 to January 2018. In vivo optical diagnosis with the level of confidence of all detected lesions were obtained before polypectomy using virtual chromoendoscopy alone or with dye-based chromoendoscopy. Our primary outcome was the negative predictive value (NPV) for neoplasia of high-confidence optical diagnosis among diminutive (≤ 5 mm) rectosigmoid lesions. Histology was the reference standard. Results: Of 147 rectosigmoid lesions, 128 were diminutive. In 103 of the 128 lesions (81%) , the optical diagnostic confidence was high, showing a NPV of 96.0% (95% confidence interval, [88.9%–98.6%]) and accuracy of 89.3% (95% confidence interval, [81.9%–93.9%]). By following the ‘diagnose-and-leave-in” policy, we would have avoided 59% (75/128) unnecessary polypectomies at expenses of 2 diminutive low-grade dysplasia adenomas and 1 diminutive sessile serrated lesion that would have been left in situ. Conclusion: In Lynch syndrome patients, the “diagnose-and-leave-in strategy” for diminutive rectosigmoid polyps would be feasible and safe.

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Section: Accepted Manuscriptcontrasting

confidence: 54%

“…From July 2016 until January 2018, 256 individuals with Lynch syndrome (60% women; mean age ± standard deviation, 47 ± 14 years) were included in the EndoLynch study [15]. Of these, 150 (59%) had at least 1 lesion, and 388 lesions were identified and removed.…”

Section: Resultsmentioning

confidence: 99%

The “diagnose and leave in” strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial

et al. 2020

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“…white-light endoscopy for the proximal colon, 77 nor did a randomized non-inferiority study comparing these two techniques for LS surveillance. 84 However, a clear time-trend toward higher ADR after the introduction of high-definition endoscopy has been observed by a recent study, also reporting development of incident cancers after the high-quality penultimate colonoscopy. 85 Currently, it is not known how much prospective, ideally randomized international multicenter studies.…”

Section: Performance Of Colonoscopy For Crc Prevention In the Genermentioning

confidence: 92%

The “unnatural” history of colorectal cancer in Lynch syndrome: Lessons from colonoscopy surveillance

Ahadova

Seppälä

Engel

et al. 2020

Intl Journal of Cancer

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Individuals with Lynch syndrome (LS), one of the most common inherited cancer syndromes, are at increased risk of developing malignancies, in particular colorectal cancer (CRC). Regular colonoscopy with polypectomy is recommended to reduce CRC risk in LS individuals. However, recent independent studies demonstrated that a substantial proportion of LS individuals develop CRC despite regular colonoscopy. The reasons for this surprising observation confirmed by large prospective studies are a matter of debate. In this review, we collect existing evidence from clinical, epidemiological and molecular studies and interpret them with regard to the origins and progression of LS-associated CRC. Alongside with hypotheses addressing colonoscopy quality and pace of progression from adenoma to cancer, we discuss the role of alternative precursors and immune system in LS-associated CRC. We also identify gaps in current knowledge and make suggestions for future studies aiming at improved CRC prevention for LS individuals.

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“…In studies where there is an element of randomization to either total or proximal colonic CE versus white light endoscopy (WLE), CE provided no additional benefit in adenoma detection. 17,18 The study by Rivero-Sanchez et al 4 is a well-designed, adequately powered, randomized noninferiority study. Unlike past studies, all procedures were performed with highdefinition systems.…”

Section: Early Detection Of Cancer To Reduce Mortalitymentioning

confidence: 99%

“…One of these is whether chromoendoscopy (CE) should be performed; this question has been addressed by Rivero-Sanchez et al in this issue of Gastroenterology. 4 Before addressing the specific question of CE, it is important to ask what is the aim of colonoscopy in LS? The aims appear uncontroversial, namely:…”

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confidence: 99%

How Should Colonoscopy Surveillance in Lynch Syndrome Be Performed?

Latchford

2020

Gastroenterology

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White-Light Endoscopy Is Adequate for Lynch Syndrome Surveillance in a Randomized and Noninferiority Study

Cited by 30 publications

References 33 publications

The “diagnose and leave in” strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial

The “diagnose and leave in” strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial

The “unnatural” history of colorectal cancer in Lynch syndrome: Lessons from colonoscopy surveillance

How Should Colonoscopy Surveillance in Lynch Syndrome Be Performed?

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