title: Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome.
abstract: OBJECTIVE
  Patients with Lynch syndrome are at increased risk of developing small-bowel adenocarcinoma, which usually has a bad prognosis and needs to be diagnosed early. Our aim was to evaluate the yield of capsule endoscopy and CT enteroclysis in this situation.
  
  
  METHODS
  We performed a prospective, blinded, comparative study of capsule endoscopy and CT enteroclysis in five academic centers. Thirty-five consecutive asymptomatic patients with Lynch syndrome, all with one proven deleterious mutation, were included. A double reading was performed blind for both types of examination.
  
  
  RESULTS
  Histologically confirmed small-bowel neoplasms were diagnosed in three patients (8.6 %): one adenocarcinoma (T3N0M0) and two adenomas with low-grade dysplasia. Capsule endoscopy identified all neoplasms. CT enteroclysis raised suspicion of one neoplasm (adenocarcinoma) but missed the two others. Concordance between the two capsule readings was high with a κ value of 0.78 (95 %CI 0.55 to 1.0), which was not the case for CT enteroclysis, where the κ value was 0.15 (95 %CI -0.27 to 0.58).
  
  
  CONCLUSIONS
  Curable early or advanced neoplasms in asymptomatic patients with Lynch syndrome using capsule endoscopy can be detected with a better reproducibility than with CT enteroclysis. The clinical usefulness of systematic small-bowel screening in these patients should be confirmed through large prospective studies.
authors.affiliation: Centre Hospitalier Lyon Sud, Pierre Bénite, France. jean-christophe.saurin@inserm.fr
authors.forename: J-C
authors.initials: JC
authors.lastname: Saurin
authors.forename: F
authors.initials: F
authors.lastname: Pilleul
authors.forename: E B
authors.initials: EB
authors.lastname: Soussan
authors.forename: T
authors.initials: T
authors.lastname: Manière
authors.forename: P N
authors.initials: PN
authors.lastname: D'Halluin
authors.forename: M
authors.initials: M
authors.lastname: Gaudric
authors.forename: C
authors.initials: C
authors.lastname: Cellier
authors.forename: D
authors.initials: D
authors.lastname: Heresbach
authors.forename: J-L
authors.initials: JL
authors.lastname: Gaudin
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000236:Adenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media