S698 Optimizing Surveillance in Lynch Syndrome: Lesion Detection and Comparative Performance of Different Colonoscopy Modalities—A Systematic Review and Network Meta-Analysis

Introduction: Lynch syndrome patients are at a high risk for developing colorectal cancer; thus, optimal surveillance strategies are required. Although colonoscopic imaging methods differ in diagnostic performance, direct comparisons in this population are not very common. We aimed to evaluate the diagnostic yield and clinical utility of white-light endoscopy (WLE), chromoendoscopy, virtual chromoendoscopy (narrow band imaging [NBI], linked color imaging [LCI], I-SCAN), and artificial intelligence (AI)-assisted colonoscopy in detecting neoplastic and non-neoplastic lesions in individuals diagnosed with Lynch syndrome. Methods: Up until March 2025, PubMed, WOS, and Scopus were searched. Relevant studies included observational or interventional designs that contrasted various forms of colonoscopy in adults with Lynch syndrome were included. The primary outcomes were lesion detection rate and number of lesions per colonoscopy. Secondary outcomes included total procedure time and withdrawal time. Credibility of the evidence was assessed employing CINeMA. Results: Nine studies were included. LCI demonstrated a significantly higher neoplastic lesion detection rate compared to WLE (RR = 1.42, 95% CI: 1.02–1.97) and detected more lesions per procedure (MD = 0.23, 95% CI: 0.01–0.45). Chromoendoscopy was better at marking the non-neoplastic lesions (RR = 1.23, 95% CI: 1.05–1.44) but had the longest procedure and withdrawal times. AI-assisted, as well as virtual ones, were better than WLE but were not as effective as LCI or chromoendoscopy. Conclusion: In terms of efficiency, LCI outperforms WLE in detecting neoplastic lesions in Lynch syndrome. Chromoendoscopy remains valuable for non-neoplastic detection, but its longer procedural time is a significant limitation. AI-assisted technologies show promise in enhancing detection, though further studies are needed to validate their effectiveness.