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. 2022 Jan;37(1):231-238.
doi: 10.1007/s00384-021-04053-y. Epub 2021 Oct 26.

Effectiveness of a surveillance program of upper endoscopy for upper gastrointestinal cancers in Lynch syndrome patients

Amanda H Ceravolo  1 , Janie J Yang  2 , Alicia Latham  3 , Arnold J Markowitz  2 , Jinru Shia  4 , Joe Mermelstein  5 , Delia Calo  2 , Hans Gerdes  2 , Emmy Ludwig  2 , Mark A Schattner  2 , Zsofia K Stadler  3   6 , Elizabeth Kantor  7 , Mengmeng Du  7 , Robin B Mendelsohn  2
Affiliations

Effectiveness of a surveillance program of upper endoscopy for upper gastrointestinal cancers in Lynch syndrome patients

Amanda H Ceravolo et al. Int J Colorectal Dis. 2022 Jan.

Abstract

Background and aims: Lynch syndrome (LS) is the most common cause of hereditary colorectal cancer and is associated with an increased lifetime risk of gastric and duodenal cancers of 8-16% and 7%, respectively; therefore, we aim to describe an esophagogastroduodenoscopy (EGD) surveillance program for upper gastrointestinal (GI) precursor lesions and cancer in LS patients.

Methods: Patients who either had positive genetic testing or met clinical criteria for LS who had a surveillance EGD at our institution from 1996 to 2017 were identified. Patients were included if they had at least two EGDs or an upper GI cancer detected on the first surveillance EGD. EGD and pathology reports were extracted manually.

Results: Our cohort included 247 patients with a mean age of 47.1 years (SD 12.6) at first EGD. Patients had a mean of 3.5 EGDs (range 1-16). Mean duration of follow-up was 5.7 years. Average interval between EGDs was 2.3 years. Surveillance EGD detected precursor lesions in 8 (3.2%) patients, two (0.8%) gastric cancers and two (0.8%) duodenal cancers. Two interval cancers were diagnosed: a duodenal adenocarcinoma was detected 2 years, 8 months after prior EGD and a jejunal adenocarcinoma was detected 1 year, 9 months after prior EGD.

Conclusions: Our data suggest that surveillance EGD is a useful tool to help detect precancerous and cancerous upper GI lesions in LS patients. To our knowledge, this is the first study to examine a program of surveillance EGDs in LS patients. More data are needed to determine the appropriate surveillance interval.

Keywords: Duodenal cancer; Gastric cancer; Hereditary nonpolyposis colorectal cancer.

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Conflict of interest statement

Conflicts of interest/competing interests: A.H.C., J.J.Y., A.L., A.J.M., J.S., J.M., D.C., H.G., E.L., M.A.S., E.K., M.D., and R.B.M. declare no conflicts of interest. Z.K.S. reports that an immediate family member holds consulting/advisory roles with Allergan, Adverum, Genentech/Roche, Gyroscope Tx, Novartis, Neurogene, Optos Plc, Regeneron, Regenxbio.

Figures

Figure 1.
Figure 1.. Flow of Patients
EGD – esophagogastroduodenoscopy LS – lynch syndrome GI - gastrointestinal MMR – mismatch repair MSI – microsatellite instability
Figure 2.
Figure 2.
Gastric Pathology Progression EGD – esophagogastroduodenoscopy
Figure 3.
Figure 3.
Duodenal Pathology Progression EGD – esophagogastroduodenoscopy
See this image and copyright information in PMC

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