SO06: Impact of an optimized colonoscopic screening program for patient with Lynch syndrome. Four years results of a specialized French network

Guillaume Perrod1,4, Elia Samaha1, Gabriel Rahmi1,4, Sherine Khater1, Leila Abbes1, Géraldine Perkins2,4, Azziz Zaanan2,4, Pierre Laurent-Puig2,4, Gilles Chatellier3,4, Georgia Malamut1,4, Christophe Cellier1,4.

1 – Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France. 2 – Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’oncologie digestive, Paris, France. 3 – Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d’Epidémiologie et de Recherche Clinique, Paris, France. 4 – Faculté de médecine René Descartes, Paris, France

Aim

Despite colonoscopic surveillance recommendations, interval colorectal cancer (ICC) remains frequent in Lynch syndrome (LS) patients. We evaluated the impact of an optimized screening program within a dedicated network.

Method

All LS patients in our institution were prospectively offered a colorectal surveillance program. Starting at the age of 20 years old, colonoscopy with indigo carmine chromoendoscopy was scheduled every 2 years. Colonoscopies were considered as optimal when all quality criteria were met. We analyzed colonoscopies’ quality, polyp detection rate (PDR), adenoma detection rate (ADR) and ICC detection rate (ICDR).

Results

Between January 2010 and January 2014, 134 confirmed LS patients were included (mean age = 47.4 years [21-78] and mutations: MLH1=41%, MSH2=43%, MSH6=14%, PMS2=2%). A total of 422 colonoscopies were analyzed. Optimal colonoscopies were more often performed after program inclusion 172/217 (79%) vs 87/205 (42%) before inclusion (p<0.0001) and 92/134 (68%) patients had all their screening colonoscopies optimal after inclusion vs 44/119 (35%) before (p<0.0001). Comparing optimal to non-optimal colonoscopies, ICDR was 1/259 (0.39%) vs 7/163 (4.29%) (p=0.006), PDR was 163/259 (62.9%) vs 58/163 (35.5%) (p<0.0001) and ADR was 72/259 (27.7%) vs 39/163 (24%) (p=0.38).

Conclusion

An optimized colonoscopic surveillance program in LS patients within a dedicated network improves colonoscopic screening quality and lesion detection rates and may reduce ICC.

Top