N41: Small Bowel Neoplasia Detection In Lynch Syndrome Using Video Capsule Endoscopy

R. A. Zuppardo1, A. Contaldo2, C. Notaristefano1, M. Di Leo3, M. B. Principi2, A. Mannucci1, S. Rizzi2, M. Grazia Patricelli4, A. Russo Raucci4, P. A. Testoni1, G. M. Cavestro1

1 – Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy. 2 – Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Italy. 3 – Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Milan, Italy. 4 – Division of Genetics and Cell Biology, Unit of Genomics for Human Disease Diagnosis, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy.


Aim: Screening for small-bowel cancer (SBC) is not yet included in surveillance guidelines for LS. In 2016 Mallorca group advised may be appropriate in MSH2 and MLH1 mutation carriers, after 40 years. Aim of the study was to determine SBC incidence in asymptomatic LS patients by means of video capsule endoscopy (VCE).

Method: Two prospective VCE databases were retrospectively reviewed to identify consecutive asymptomatic LS patients, compared with a group of patients who underwent VCE for obscure gastrointestinal bleeding (OBS).

Results: 25 LS patients and 280 OBS patients were enrolled by two Italian centers. In 91.5%, caecal visualization was achieved.  SBC was detected in two LS patients and three OBS patients (p=0.06). The two groups have a significant statistically different mean age (SD): 41.3 ys± 14.0 ys in LS group and 62.9 ys ± 17.2 ys in OBS group.  Besides SBC, LS patients and OBS patients have statistically significant difference in incidence of vascular lesion, angiectasia and minute polyps.

Conclusion: The prevalence of SBC in asymptomatic patients with LS was 8% vs 1.1%. Although the incidence of SMC did not reach statistical significance difference, a trend through statistically significant difference was observed and this suggests further multicentric studies are needed.