Utility of Oesophagogastroduodenoscopy in Lynch Syndrome

This study aims to investigate the outcomes in Lynch syndrome associated with routine second-yearly oesophagogastroduodenoscopy (OGD).

The role of OGD for surveillance in Lynch syndrome remains contentious, with variation in guidelines. Our service runs a dedicated high-risk gastrointestinal risk management clinic where OGD is offered every second year after recruitment into surveillance.

Patients with Lynch syndrome who underwent at least one OGD were retrospectively reviewed. Demographics, clinical risk factors, personal and family history of malignancy, and endoscopic/histologic findings at OGD were evaluated. Logistic regression, Kaplan-Meier and Cox regression analysis were used to evaluate factors associated with premalignant and malignant lesions.

A total of 296 patients were identified, with a total of 962 OGDs performed. Dysplasia was identified in 9 patients (3.0%), the majority of which were in the duodenum (66.7%). Two cases (0.7%) were diagnosed with duodenal adenocarcinoma. Premalignant lesions were seen in 20.9% (3.7% Barrett's metaplasia, 16.2% GIM, 1.0% both). Multivariable analysis did not identify predictors of dysplasia or malignancy. Tobacco smoking was associated with premalignant lesions at baseline and on follow-up.

Our Lynch syndrome cohort demonstrated high rates of premalignant, dysplastic or malignant lesions (22.6%). High-risk lesions showed a predilection for the duodenum. This study suggests a role for routine OGD in patients with Lynch syndrome.