Utility of Oesophagogastroduodenoscopy in Lynch Syndrome

GOAL: This study aims to investigate the outcomes in Lynch syndrome associated with routine second-yearly oesophagogastroduodenoscopy (OGD). BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.