Background and Aims
Lynch syndrome (LS) predisposes affected individuals to a high lifetime risk of malignancies,
including colorectal, endometrial, gastric, and duodenal cancers. The role of upper
GI (UGI) cancer screening in LS has been uncertain, but recent studies have evaluated
its utility.
Methods
Databases were queried through December 2021 to identify studies that examined upper
endoscopy screening in LS using EGD. Mantel-Haenszel pooled odds ratios and 95% confidence
intervals (CIs) for outcomes were constructed using a random-effects model to identify
pooled odds of endoscopic findings in persons with LS. Event rates for detection of
gastric and duodenal cancers, high-risk lesions, and clinically actionable findings
were calculated. Statistical heterogeneity was assessed using the I2 statistic.
Results
Nine studies were identified with 2356 LS patients undergoing approximately 7838 EGDs.
In total, 47 LS-associated UGI cancers (18 gastric and 29 duodenal cancers), 237 high-risk
lesions, and 335 clinically actionable findings were identified. The pooled event
rate for detection of any UGI cancer, high-risk lesions, and clinically actionable
findings during screening were .9% (95% CI, .3-2.1; I2 = 89%), 4.2% (95% CI, 1.6-10.9; I2 = 98%), and 6.2% (95% CI, 2.2-16.5; I2 = 99%), respectively. There was no difference between LS-associated gene and gastric
or duodenal cancer detection.
Conclusions
In LS, there is evidence that endoscopic screening detects UGI cancers, precancerous
lesions, and other clinically actionable findings that favor its use as a part of
cancer risk management in LS.
Abbreviations:
CI (confidence interval), HP (Helicobacter pylori), LS (Lynch syndrome), PIR (pooled incidence rate), UGI (upper GI)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 06, 2022
Accepted:
August 30,
2022
Received:
July 6,
2022
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
