P7: Capsule endoscopy and magnetic resonance enterography for small bowel neoplasia screening in Lynch Syndrome

Elia Samaha1, Leila Abbess1, Gabriel Rahmi1,4, Joel Edery1, Charles-André Cuenod2,4, Nathalie Siauve2, Georgia Malamut1,4, Géraldine Perkins3, Aziz Zaanan3, Pierre Laurent-Puig3,4, Cellier Christophe1,4. On behalf of the PRED-IdF network.

1 – Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital. 20 rue Leblanc, 75015 Paris. 2 – Radiology Unit, Georges Pompidou European Hospital. 20 rue Leblanc, 75015 Paris. 3 – Oncogenetic department, Georges Pompidou European Hospital. 20 rue Leblanc, 75015 Paris. 4 – Paris Descartes University, Paris

Aim

To determine the prevalence/incidence of small-bowel neoplasia in patients with Lynch syndrome (LS) after registration to a follow-up specialized network.

Method

Patients with genetically proven LS were included in the PREd-IdF network, and were offered a small bowel cancer (SBC) screening using capsule endoscopy (CE), magnetic resonance enterography (MRE) or CT enteroclysis (CTE) every two years. Data were collected retrospectively.

Results

Between January 2010 and December 2015, 139 patients (Mean age 47 years (range 23-75), M/F=55/84, mean follow-up 50 months (range 1-105)) with proven mutations were included (MLH1 37%, MSH2 46%, MSH6 14%, PMS2 2% and EPCAM 1%). In total, 136 patients underwent 256 CE procedures, 110 patients underwent 142 MREs and 5 patients 5 CTEs.  Six small bowel neoplasias were detected in 5 patients: 3 adenocarcinomas (ADK)  (2 in the proximal jejunum and one ileal) and 3 adenomas (one duodenal, one jejunal and one ileal).  CE detected 5/6 neoplasia (2 ADK and 3 adenomas) and missed one ADK while MRE/CTE found 2 ADK and missed one ADK and 3 adenomas. Three out of the five patients were asymptomatic (One with an ADK and two with adenomas). The number needed to diagnose one neoplasia in LS patients was 28.

Conclusion

The prevalence of small bowel neoplasia in patients with LS was 3.6 % in general and 2.2% in asymptomatic carriers whereas the incidence was 1% per year. CE found more neoplastic lesions than MRE or CTE.

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