Lynch Syndrome Colonoscopy: Quality Matters

Douglas K. Rex, MD, MASGE reviewing Sánchez A, et al. Clin Gastroenterol Hepatol 2020 Nov 2.

In the U.S., colonoscopy is usually performed at 1- to 2-year intervals in Lynch syndrome.

This multicenter study evaluated the relationship of adenoma detection and postcolonoscopy colorectal cancer (PCCRC) to quality indicators. The actual adenoma detection rates (ADR) of the endoscopists were not known.

Among 893 Lynch syndrome carriers undergoing surveillance colonoscopy, the 10-year cumulative incidence of adenoma and PCCRC was 60.6% and 7.9%, respectively. Overall, adenoma detection was associated with adequate bowel preparation, complete colonoscopy to the cecum, and panchromoendoscopy. There was a 65% reduction in PCCRC with colonoscopy intervals <3 years. There were trends toward reduction in PCCRC with previous complete examination, adequate bowel preparation, and use of high-definition colonoscopes, with likely insufficient numbers of PCCRC to reach significance. PCCRC was associated with mutations in MLH1/MHS2 versus MSH6/PMS2.

Comment:

It’s highly likely that the ADR of the endoscopist would also be associated with PCCRC if available for study. Indirectly, the association of complete examination, high-quality preparation, and panchromoendoscopy with adenoma detection support the need for attention to complete, high-quality examinations.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures

Citation(s):

Sánchez A, Roos VH, Navarro M, et al. Quality of colonoscopy is associated with adenoma detection and post-colonoscopy colorectal cancer prevention in Lynch syndrome. Clin Gastroenterol Hepatol 2020 Nov 2. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.11.002)