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Effectiveness of a surveillance program of upper endoscopy for upper gastrointestinal cancers in Lynch syndrome patients

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Lynch syndrome (LS) is the most common cause of hereditary colorectal cancer and is associated with an increased lifetime risk of gastric and duodenal cancers of 8–16% and 7%, respectively; therefore, we aim to describe an esophagogastroduodenoscopy (EGD) surveillance program for upper gastrointestinal (GI) precursor lesions and cancer in LS patients.

Methods

Patients who either had positive genetic testing or met clinical criteria for LS who had a surveillance EGD at our institution from 1996 to 2017 were identified. Patients were included if they had at least two EGDs or an upper GI cancer detected on the first surveillance EGD. EGD and pathology reports were extracted manually.

Results

Our cohort included 247 patients with a mean age of 47.1 years (SD 12.6) at first EGD. Patients had a mean of 3.5 EGDs (range 1–16). Mean duration of follow-up was 5.7 years. Average interval between EGDs was 2.3 years. Surveillance EGD detected precursor lesions in 8 (3.2%) patients, two (0.8%) gastric cancers and two (0.8%) duodenal cancers. Two interval cancers were diagnosed: a duodenal adenocarcinoma was detected 2 years, 8 months after prior EGD and a jejunal adenocarcinoma was detected 1 year, 9 months after prior EGD.

Conclusions

Our data suggest that surveillance EGD is a useful tool to help detect precancerous and cancerous upper GI lesions in LS patients. To our knowledge, this is the first study to examine a program of surveillance EGDs in LS patients. More data are needed to determine the appropriate surveillance interval.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are not publicly available due to The Health Insurance Portability and Accountability Act of 1996 but are available from the corresponding author on reasonable request (de-identified).

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Funding

This work was supported by grant P30 CA008748/CA/NCI NIH HHS/United States.

Author information

Authors and Affiliations

  1. Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Amanda H. Ceravolo

  2. Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Janie J. Yang, Arnold J. Markowitz, Delia Calo, Hans Gerdes, Emmy Ludwig, Mark A. Schattner & Robin B. Mendelsohn

  3. Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Alicia Latham & Zsofia K. Stadler

  4. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jinru Shia

  5. Division of Gastroenterology, Department of Medicine, Cooper University Health Care, Camden, NJ, USA

    Joe Mermelstein

  6. Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Zsofia K. Stadler

  7. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Elizabeth Kantor & Mengmeng Du

Authors
  1. Amanda H. Ceravolo
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  2. Janie J. Yang
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Contributions

A.H.C. data curation: lead, formal analysis: lead, investigation: equal, methodology: equal, writing—original draft: lead, writing—review and editing: equal; J.J.Y. conceptualization: equal, data curation: equal, formal analysis: equal, investigation: equal, methodology: equal, project administration: equal, supervision: equal, writing—original draft: equal, writing—review and editing: equal; A.L. formal analysis: supporting, supervision: supporting, writing—review and editing: supporting; A.J.M. writing—review and editing: equal; J.S. data curation: supporting, supervision: supporting, writing—review and editing: supporting; J.M. data curation: equal; D.C. writing—review and editing: supporting; H.G. writing—review and editing: supporting; E.L. writing—review and editing: supporting; M.A.S. writing—review and editing: supporting; Z.K.S. writing—review and editing: supporting; E.K. funding acquisition: supporting; writing—review and editing: supporting; M.D. writing—review and editing: supporting; R.B.M. conceptualization: lead, formal analysis: equal, investigation: equal, methodology: equal, project administration: lead, supervision: lead, writing—original draft: equal, writing—review and editing: equal.

Corresponding author

Correspondence to Amanda H. Ceravolo.

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Ethics approval

MSKCC’s Institutional Review Board approved this study.

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Not applicable.

Conflict of interest

A.H.C., J.J.Y., A.L., A.J.M., J.S., J.M., D.C., H.G., E.L., M.A.S., E.K., M.D., and R.B.M. declare no conflicts of interest. Z.K.S. reports that an immediate family member holds consulting/advisory roles with Allergan, Adverum, Genentech/Roche, Gyroscope Tx, Novartis, Neurogene, Optos Plc, Regeneron, and Regenxbio.

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Ceravolo, A.H., Yang, J.J., Latham, A. et al. Effectiveness of a surveillance program of upper endoscopy for upper gastrointestinal cancers in Lynch syndrome patients. Int J Colorectal Dis 37, 231–238 (2022). https://doi.org/10.1007/s00384-021-04053-y

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  • DOI: https://doi.org/10.1007/s00384-021-04053-y

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