Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome

• Published in: Endoscopy Vol. 42; no. 12; p. 1057
• Main Authors: Saurin, J-C, Pilleul, F, Soussan, E B, Manière, T, D'Halluin, P N, Gaudric, M, Cellier, C, Heresbach, D, Gaudin, J-L
• Format: Journal Article
• Language: English
• Published: Germany 01-12-2010
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - diagnostic imaging; Adenoma - diagnosis; Adenoma - diagnostic imaging; Adult; Aged; Capsule Endoscopy; Colorectal Neoplasms, Hereditary Nonpolyposis - complications; Contrast Media - administration & dosage; Female; Humans; Intestinal Neoplasms - diagnosis; Intestinal Neoplasms - diagnostic imaging; Intestinal Neoplasms - etiology; Intestine, Small - diagnostic imaging; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Single-Blind Method; Tomography, X-Ray Computed
• ISSN: 1438-8812
• DOI: 10.1055/s-0030-1255742

Patients with Lynch syndrome are at increased risk of developing small-bowel adenocarcinoma, which usually has a bad prognosis and needs to be diagnosed early. Our aim was to evaluate the yield of capsule endoscopy and CT enteroclysis in this situation.
We performed a prospective, blinded, comparative study of capsule endoscopy and CT enteroclysis in five academic centers. Thirty-five consecutive asymptomatic patients with Lynch syndrome, all with one proven deleterious mutation, were included. A double reading was performed blind for both types of examination.
Histologically confirmed small-bowel neoplasms were diagnosed in three patients (8.6 %): one adenocarcinoma (T3N0M0) and two adenomas with low-grade dysplasia. Capsule endoscopy identified all neoplasms. CT enteroclysis raised suspicion of one neoplasm (adenocarcinoma) but missed the two others. Concordance between the two capsule readings was high with a κ value of 0.78 (95 %CI 0.55 to 1.0), which was not the case for CT enteroclysis, where the κ value was 0.15 (95 %CI -0.27 to 0.58).
Curable early or advanced neoplasms in asymptomatic patients with Lynch syndrome using capsule endoscopy can be detected with a better reproducibility than with CT enteroclysis. The clinical usefulness of systematic small-bowel screening in these patients should be confirmed through large prospective studies.