N45: High-Definition White-Light Colonoscopy Versus Chromoendoscopy For Surveillance Of Lynch Syndrome. A Multicenter, Randomized And Controlled Study (Endolynch Study)

L. Rivero-Sánchez1, 2, 3, 4, C. Arnau4, F. Balaguer1, 2, 3, 4, 5, J. Herrero6, D. Remedios6, V. Alvarez7, E. Albéniz8, P. Calvo8, J. Gordillo9, I. Puig10, J. López Vicente11, A. Huerta12, M. López-Cerón13, I. Salces13, B. Peñas14, S. Parejo14, M. Herraiz15, A. Gimeno16, E. Saperas17, C. Alvarez18, L. Moreno4, C. Rodriguez de Miguel13, M. Diaz4, T. Ocaña12, L. Moreira1, 2, 3, 4,5, M. Cuatrecasas1, 19, S. Carballal1, 2, 3, 4, 5, A. Sánchez1, 2, 3, 4, 5, J. Llach1, 2, 3, M. Pellisé1, 2, 3, 4, 5

1 – Hospital Clinic de Barcelona. 2 – Department of Gastroenterology. 3 – Digestive Endoscopy Unit. 4 – Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS). Barcelona, Spain. 5 – Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd). Barcelona, Spain. 6 – Complexo Hospitalario Universitario de Ourense, Department of Gastroenterology, Orense, Spain. 7 – Complejo Hospitalario de Pontevedra, Department of Gastroenterology, Pontevedra, Spain. 8 – Complejo Hospitalario de Navarra, Digestive System Service, Pamplona, Spain. 9 – Hospital de la Santa Creu i Sant Pau, Gastroenterology Unit, Barcelona, Spain. 10 – Althaia, Xarxa Assistencial Universitària de Manresa, Digestive System Service, Manresa, Spain. 11 – Hospital Universitario de Móstoles, Digestive System Service, Móstoles, Spain. 12 – Hospital Galdakao-Usansolo, Department of Gastroenterology, Galdakao, Spain. 13 – Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain. 14 – Hospital Ramón y Cajal, Department of Gastroenterology, Madrid, Spain. 15 – Clínica Universitaria de Navarra, Digestive System Service, Pamplona, Spain. 16 – Hospital Universitario de Canarias, Digestive System Service, Santa Cruz de Tenerife, Spain. 17 – Hospital General de Catalunya, Digestive System Service, Sant Cugat del Vallès, Spain. 18 – Hospital del Mar, Digestive System Service, Barcelona, Spain. 19 – Department of Pathology. Barcelona, Spain.

 

Aim: The use of pan-chromoendoscopy (CE) for surveillance in Lynch syndrome is currently recommended despite low evidence. We aimed to demonstrate that high-definition white-light endoscopy (WLE) is not inferior to CE for detection of adenomas.

Method: Patients with confirmed germline mismatch repair mutation were prospectively randomized 1:1 to WLE or CE performed by endoscopists devoted to high-risk conditions of colorectal cancer. The main outcome was the adenoma detection rate.

Results: 256 patients (60% women; age 47±14y) were included in 14 centers. The detection rate of lesions in WLE versus CE group were: adenomas 28.1% versus 34.4% respectively (p=0.281), total polyps 50.0% versus 57.7% (p=0.004), proximal serrated lesions (SL) 10.2% versus 11.7% (p=0.689), sessile SL 5.5% versus 3.9%(p=0.554) and advanced adenomas 7.8% (4.3%-13.7%) versus 3.9% (1.6%-3.9%) (p=0.183) respectively. The mean (standard deviation) of lesions per patient for WLE versus CE were: adenomas 1.04 (1.37) versus 0.86 (1.04) (p=0.670),proximal SL 0.25 (0.56) versus 0.25 (0.61) (p=0.426),sessile SL 0.10 (0.31) versus 0.11 (0.67) (p=0.660),left-sided SL 0.21 (0.55) versus 0.53 (1.04) (p=0.002) respectively.The withdrawal time (minutes) for WLE and CE were 13.5  (5.63) versus 18.37 (7.57)(p<0.001) respectively.

Conclusion: In a scenario with expert endoscopists, WLE is an optimal and efficient endoscopic technique for surveillance of Lynch syndrome patients.

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