title: Prevalence of small-bowel neoplasia in Lynch syndrome assessed by video capsule endoscopy.
abstract: OBJECTIVE
  The aim was to determine the prevalence of small-bowel neoplasia in asymptomatic patients with Lynch syndrome (LS) by video capsule endoscopy (VCE).
  
  
  METHODS
  After obtaining informed consent, asymptomatic proven gene mutation carriers aged 35-70 years were included in this prospective multicentre study in the Netherlands. Patients with previous small-bowel surgery were excluded. After bowel preparation, VCE was performed. The videos were read by two independent investigators. If significant lesions were detected, an endoscopic procedure was subsequently performed to obtain histology and, if possible, remove the lesion.
  
  
  RESULTS
  In total, 200 patients (mean age 50 years (range 35-69), M/F 88/112), with proven mutations were included. These concerned MLH1 (n = 50), MSH2 (n = 68), MSH6 (n = 76), PMS2 (n = 3) and Epcam (n = 3) mutation carriers. In 95% of the procedures, caecal visualisation was achieved. Small-bowel neoplasia was detected in two patients: one adenocarcinoma (TisN0Mx) and one adenoma, both located in the duodenum. In another patient, a duodenal cancer (T2N0Mx) was diagnosed 7 months after a negative VCE. This was considered a lesion missed by VCE. All three neoplastic lesions were within reach of a conventional gastroduodenoscope. All patients with neoplasia were men, over 50 years of age and without a family history of small-bowel cancer.
  
  
  CONCLUSIONS
  The prevalence of small-bowel neoplasia in asymptomatic patients with LS was 1.5%. All neoplastic lesions were located in the duodenum and within reach of conventional gastroduodenoscopy. Although VCE has the potential to detect these neoplastic lesions, small-bowel neoplasia may be missed.
  
  
  BACKGROUND
  NCT00898768.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jasmijn F
authors.initials: JF
authors.lastname: Haanstra
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Abdul
authors.initials: A
authors.lastname: Al-Toma
authors.affiliation: Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.affiliation: Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, The Netherlands.
authors.forename: Steven A L W
authors.initials: SA
authors.lastname: Vanhoutvin
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Fokko M
authors.initials: FM
authors.lastname: Nagengast
authors.affiliation: Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: Mathus-Vliegen
authors.affiliation: Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, The Netherlands Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Monique E
authors.initials: ME
authors.lastname: van Leerdam
authors.affiliation: Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Wouter H
authors.initials: WH
authors.lastname: de Vos tot Nederveen Cappel
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanduleanu
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Roeland A
authors.initials: RA
authors.lastname: Veenendaal
authors.affiliation: Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, The Netherlands.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Cats
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands.
authors.forename: Hans F A
authors.initials: HF
authors.lastname: Vasen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Kleibeuker
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Koornstra
mesh_terms: D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000453:epidemiology*; D003937:Diagnosis, Differential; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies
keywords: ENDOSCOPY; HNPCC SYNDROME