Surveillance of the small-bowel by capsule endoscopy in Lynch syndrome - A systematic review with meta-analysis.

Capsule endoscopy HNPCC Lynch syndrome Screening Small bowel

Journal

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385

Informations de publication

Date de publication:
08 Aug 2023
Historique:
received: 14 06 2023
revised: 23 07 2023
accepted: 24 07 2023
medline: 11 8 2023
pubmed: 11 8 2023
entrez: 10 8 2023
Statut: aheadofprint

Résumé

The role of small-bowel (SB) cancer surveillance by capsule endoscopy (CE) in Lynch syndrome (LS) patients has been investigated in recent years, with contradicting results. This meta-analysis evaluates the diagnostic yield (DY) of CE as a screening tool in asymptomatic LS patients. A systematic literature search was performed for all studies reporting the results of SB cancer screening in patients with LS. The primary outcome was the evaluation of the DY of CE in this setting for consecutive screening rounds. Five studies comprising 428 patients and CE 677 procedures were included for data extraction and statistical analysis. The estimated pooled DY for CE-identified pathological findings was 8% in the first screening round and 6% in the second. Limiting the analysis to histologically-confirmed pathological findings, the pooled DY of second-round screening dropped to 0%. The included studies showed a significantly different prevalence of pathogenic variants in mismatch repair (path_MMR) genes, which underlie different cumulative incidences of extracolonic cancers. SB surveillance by CE with a 2-year interval in asymptomatic LS individuals does not appear to be an effective screening strategy. Confirmatory prospective studies in this context are needed, considering the different cumulative incidence of SB tumors according to underlying path_MMR defects.

Sections du résumé

BACKGROUND & AIMS OBJECTIVE
The role of small-bowel (SB) cancer surveillance by capsule endoscopy (CE) in Lynch syndrome (LS) patients has been investigated in recent years, with contradicting results. This meta-analysis evaluates the diagnostic yield (DY) of CE as a screening tool in asymptomatic LS patients.
METHODS METHODS
A systematic literature search was performed for all studies reporting the results of SB cancer screening in patients with LS. The primary outcome was the evaluation of the DY of CE in this setting for consecutive screening rounds.
RESULTS RESULTS
Five studies comprising 428 patients and CE 677 procedures were included for data extraction and statistical analysis. The estimated pooled DY for CE-identified pathological findings was 8% in the first screening round and 6% in the second. Limiting the analysis to histologically-confirmed pathological findings, the pooled DY of second-round screening dropped to 0%. The included studies showed a significantly different prevalence of pathogenic variants in mismatch repair (path_MMR) genes, which underlie different cumulative incidences of extracolonic cancers.
CONCLUSIONS CONCLUSIONS
SB surveillance by CE with a 2-year interval in asymptomatic LS individuals does not appear to be an effective screening strategy. Confirmatory prospective studies in this context are needed, considering the different cumulative incidence of SB tumors according to underlying path_MMR defects.

Identifiants

DOI: 10.1016/j.dld.2023.07.028 PMID: 37563008
pubmed: 37563008
pii: S1590-8658(23)00780-6
doi: 10.1016/j.dld.2023.07.028
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of interest The listed Authors declare the following potential COIs P.C.V.: lecture fees (Jinshan Ltd.) M.P.: lecture fees (Medtronic and Olympus) A.K.: co-founder and shareholder of AJM Medicaps; co-director and shareholder of iCERV Ltd.; consultancy fees (Jinshan Ltd.); travel support (Jinshan, Aquilant and Falk Pharma); research support (grant) from ESGE/Given Imaging Ltd. and (material) IntroMedic/SynMed; honoraria (Falk Pharma UK, Ferring, Jinshan, Medtronic). Member of Advisory board meetings (Falk Pharma UK, Tillots, ANKON). U.D., T.B-M., F.G., L.L.: no COIs

Auteurs

Pablo Cortegoso Valdivia (P)

Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, 43125, Parma, Italy. Electronic address: cortegosopablo@yahoo.it.

Ulrik Deding (U)

Department of Clinical Research, University of Southern Denmark, 5230, Odense, Denmark; Department of Surgery, Odense University Hospital, 5000, Odense, Denmark.

Thomas Bjørsum-Meyer (T)

Department of Clinical Research, University of Southern Denmark, 5230, Odense, Denmark; Department of Surgery, Odense University Hospital, 5000, Odense, Denmark.

Marco Pennazio (M)

University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, 10126, Turin, Italy.

Federica Gaiani (F)

Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, 43125, Parma, Italy; Department of Medicine and Surgery, University of Parma, 43125, Parma, Italy.

Anastasios Koulaouzidis (A)

Department of Clinical Research, University of Southern Denmark, 5230, Odense, Denmark; Department of Gastroenterology, OUH Svendborg Sygehus, 5700, Svendborg, Denmark; Surgical Research Unit, Odense University Hospital, 5000, Odense, Denmark; Department of Social Medicine and Public Health, Pomeranian Medical University, 70204, Szczecin, Poland.

Luigi Laghi (L)

Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, 43125, Parma, Italy; Department of Medicine and Surgery, University of Parma, 43125, Parma, Italy; Molecular Gastroenterology Laboratory, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy.

Classifications MeSH