Neoplasia outcomes following colonoscopy for Lynch syndrome at a dedicated center vs. community centers

The European Society for Gastrointestinal Endoscopy recommends Lynch syndrome patients be followed in centers that monitor compliance and measure endoscopic performance. It is unclear if this policy impacts neoplasia outcomes. We investigated whether neoplasia outcomes were better at a dedicated center vs. community-based endoscopy centers.

We reviewed findings of surveillance colonoscopy in 129 Lynch patients according to whether the previous colonoscopy was performed at a community vs. dedicated center and compared detection rates of advanced lesions (cancers plus advanced precancerous lesions) at colonoscopy.

There were five cancers identified at a surveillance colonoscopy: one after a colonoscopy at the dedicated center at an interval of 137 months and four after community center colonoscopies at intervals of 12, 14, 26, and 77 months. Detection of advanced lesions (cancer plus advanced precancerous lesions) was higher after colonoscopy performed at community centers compared with the dedicated center (12.0% vs 4.1%; odds ratio [OR] 3.20; 95% confidence interval [CI] 1.30-7.90). The cancer detection rate after previous colonoscopy at community centers was 4.3%, compared with 0.4% after colonoscopy at the dedicated center (OR 12.23; 95% CI 1.4-107.2). The interval between previous and surveillance colonoscopy was longer if the previous colonoscopy was performed at a community center (934 +/- 1037 days vs. 589 +/- 445 days; P = 0.006).

A dedicated center with consistently high colonoscopy performance measures and navigation to augment patient adherence provided superior neoplasia outcomes in Lynch syndrome patients compared with community colonoscopy centers.