Endoscopic screening for upper gastrointestinal tumors can detect malignancies and precancerous lesions in patients with Lynch syndrome. This is the conclusion of researchers from the universities of Florida and Pennsylvania after a meta-analysis of several studies using this screening.
Patients with Lynch syndrome (LS) have a lifetime risk of malignancies, including colorectal, endometrial, gastric and duodenal cancers. The role of screening for upper gastrointestinal tumors is not yet clear, but has been investigated in recent studies. The American researchers have done a meta-analysis of this. They searched for studies with endoscopic screening via esophagogastroduodenoscopy (EGD) and calculated event rates for the detection of gastric and duodenal cancers, high-risk lesions and clinically relevant findings.
The researchers found 9 studies, with 2,356 patients with LS who had undergone more than 7,800 EGDs. 47 LS-associated cancers (18 gastric and 29 duodenal) were identified, 237 high-risk lesions and 335 clinically relevant findings. The pooled event rate for detection of any upper gastrointestinal tumour, high risk lesion and clinically relevant finding during screening was 0.9, 4.2 and 6.2%, respectively.
The researchers conclude that there is evidence that endoscopic screening in LS patients can detect upper gastrointestinal tumors, premalignant lesions and other clinically relevant abnormalities. This argues for the use of such screening as part of risk management for malignancies in Lynch syndrome.
Vedantam S, Katona BW, Sussman DA, et al. Outcomes of Upper Endoscopy Screening in Lynch Syndrome: A Meta-Analysis. Gastrointest Endosc. 2022;S0016-5107(22)01949-6. Online ahead of print.