S706 Combining Endometrial Biopsy With Endoscopy Surveillance in Lynch Syndrome: A Feasible and Patient-Centered Strategy

Introduction: Lynch syndrome (LS) is the most common hereditary gastrointestinal cancer syndrome. LS carriers have significantly increased lifetime risk of several malignancies. National Comprehensive Cancer Network (NCCN) guidelines recommend surveillance with colonoscopy every 1-2 years, upper endoscopy every 2-4 years, and endometrial biopsy (EMB) every 1-2 years. EMBs are typically performed without sedation and are often reported as painful. Discomfort, paired with an intensive surveillance schedule, can be burdensome and negatively affect adherence. Our study evaluates the feasibility and patient-centered outcomes of performing EMB concurrently with sedated endoscopic procedures. Methods: Patients with a confirmed LS germline pathogenic variant who consented to participate in an IRB-approved registry were included. Under sedation, endoscopic procedures (colonoscopy and/or upper endoscopy) were performed first by a gastroenterologist, followed by EMB by a trained provider. A chart review captured patient characteristics, clinical history, and procedural details. A REDCap survey was administered post-procedure to assess patient-reported outcomes. Results: Participant were between ages 30 and 76, with median age of 42. All had a confirmed LS related germline pathogenic variant: MSH6 (36%), PMS2 (29%), MSH2 (25%), or MLH1 (11%). Among 28 enrolled patients, 14 had previously undergone EMB and 9 had at least one prior awake EMB in the clinic. These 9 patients had a total of 26 prior EMBs among them, of which there were 5 failed attempts (19%). Only 1 patient who had a failed EMB attempt while awake also had a failed EMB attempt with sedation. For total EMBs performed under sedation, 5 of 37 (14%) were unsuccessful. No post-procedural complications were reported. Pathology was benign for all EMB specimens. On follow-up survey (N = 8), patients reported significantly lower anxiety and pain both during and after EMB with sedation compared to without. All preferred undergoing future EMBs with sedation and indicated increased likelihood to complete EMBs if offered with sedation. Conclusion: Performing EMB concurrently with sedated endoscopic procedures is feasible and provides substantial patient-centered benefits, including reduced procedural anxiety and discomfort. This integrated approach may enhance adherence to recommended surveillance and aligns with the principles of patient-centered care. Broader implementation should be considered by centers offering these surveillance options for LS carriers.