P27: Chromoendoscopy in combination with random biopsies does not improve detection of gastric cancer foci in CDH1 mutation positive patients

Robert Hüneburg1,5*, Tim Marwitz1*, Peer van Heteren1,5, Tobias J Weismüller1,5, Jonel Trebicka1, Ronja Adam2,5, Stefan Aretz2,5, Alberto Perez Bouza3,5, Dimitrios Pantelis4,5, Jörg C Kalff4,5, Jacob Nattermann1,5, Christian P Strassburg1,5§

* – both authors contributed equally, § – shared senior authorship

1 – Department of Internal Medicine I, University Hospital Bonn. 2 – Institute of Human Genetics, University Hospital Bonn. 3 – Institute of Pathology, University Hospital Bonn. 4 – Department of Surgery, University Hospital Bonn. 5 – Center for Hereditary Tumour Syndromes, University Hospital Bonn


Hereditary diffuse gastric cancer (HGGC) accounts for 1-3% of gastric cancers worldwide. Patients with proven CDH1 mutation are advised to undergo prophylactic total gastrectomy (PTG) as current endoscopic surveillance protocols often fail to detect microscopic disease.  Here, we studied the diagnostic performance of pan-gastric chromoendoscopy using indigo carmine combined with targeted and multiple random biopsies.


Patients with a proven CDH1 germline mutation were examined using high-resolution white-light endoscopy and pan-gastric chromoendoscopy with indigo carmine combined with targeted and a minimum of 30 random biopsies prior to PTG. Postoperative histopathology was compared with endoscopic findings.


Eight CDH1 germline mutation carriers underwent upper gastrointestinal endoscopy. One patient had to be excluded from further analysis due to violation of the endoscopy protocol. In the remaining seven patients 44 targeted (6.3/patient) and 225 random (32.1/patient) biopsies were taken, which identified a single focus of gastric cancer in a random biopsy. In contrast, histopathology of gastrectomy specimen revealed multiple foci of gastric carcinoma in 6 of 7 patients (86%) with a total number of 27 cancer foci.


Chromoendoscopy combined with random biopsies does not enable sensitive detection of gastric cancer foci in CDH1 mutation carriers.