Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome.
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.
Saurin
J-C
JC
Centre Hospitalier Lyon Sud, Pierre Bénite, France. jean-christophe.saurin@inserm.fr
Pilleul
F
F
Soussan
E B
EB
Manière
T
T
D'Halluin
P N
PN
Gaudric
M
M
Cellier
C
C
Heresbach
D
D
Gaudin
J-L
JL
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
D003287:Contrast Media