title: Impact of chromoscopy on adenoma detection in patients with Lynch syndrome: a prospective, multicenter, blinded, tandem colonoscopy study.
abstract: OBJECTIVE
  In Lynch syndrome, flat and diminutive adenomas are particularly prone to malignant transformation, but they can be missed by standard colonoscopy. It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome.
  
  
  METHODS
  We conducted a prospective, multicenter, randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy. Standard colonoscopy was used first to detect visible lesions. Colonoscopy with chromoscopy was then performed by a second gastroenterologist (blinded to the findings of the first colonoscopy) to detect additional lesions. The primary end point was the number of patients in whom at least one adenoma was detected.
  
  
  RESULTS
  A total of 78 eligible patients (median age, 45 years) were enrolled at 10 centers from July 2008 to August 2009. Significantly more patients with at least one adenoma were identified by chromocolonoscopy (32/78 (41%)) than by standard colonoscopy (18/78 (23%); P<0.001). The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was 31% (24/78). Overall, chromocolonoscopy plus colonoscopy detected a total of 55 adenomas in 32 patients (mean number of adenomas detected per patient: 0.7 vs. standard colonoscopy alone: 0.3; P<0.001).
  
  
  CONCLUSIONS
  The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome.
authors.affiliation: 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rahmi
authors.affiliation: 1] Université François-Rabelais, Paris, France [2] Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lecomte
authors.affiliation: Département de Médecine Oncologique, Unité d'oncologie digestive, Institut Gustave Roussy, Villejuif, France.
authors.forename: David
authors.initials: D
authors.lastname: Malka
authors.affiliation: 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Maniere
authors.affiliation: Service d'Hépato-gastroentérologie, CHU de Nantes, Nantes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Le Rhun
authors.affiliation: 1] Service d'oncologie, Hôpital Purpan, Toulouse, France [2] Université de Toulouse 3 University, Toulouse, France.
authors.forename: Rosine
authors.initials: R
authors.lastname: Guimbaud
authors.affiliation: Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Marie-Georges
authors.initials: MG
authors.lastname: Lapalus
authors.affiliation: Service d'Hépato-gastroentérologie, CHU Dupuytren, Limoges, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Le Sidaner
authors.affiliation: Service de Gastroentérologie, Hôpital Lyon Sud, Lyon, France.
authors.forename: Driffa
authors.initials: D
authors.lastname: Moussata
authors.affiliation: Service d'oncogénétique, Institut Gustave Roussy, Villejuif, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Caron
authors.affiliation: Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Barbieux
authors.affiliation: Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Cochin, Paris, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Gaudric
authors.affiliation: Service d'Hépato-gastroentérologie, CHU de Nantes, Nantes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Purpan, Toulouse, France.
authors.forename: Karl
authors.initials: K
authors.lastname: Barange
authors.affiliation: Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.affiliation: Service d'Hépato-gastroentérologie, CHU Dupuytren, Limoges, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Sautereau
authors.affiliation: Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Elia
authors.initials: E
authors.lastname: Samaha
authors.affiliation: Service de Gastroentérologie, Hôpital Lyon Sud, Lyon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Saurin
authors.affiliation: 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Cochin, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
authors.affiliation: 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Unité d'oncogénétique, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Laurent-Puig
authors.affiliation: 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Unité d'épidémiologie et de recherche clinique, Hôpital européen Georges Pompidou, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.affiliation: 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D000328:Adult; D002277:Carcinoma / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D003106:Colon / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications / Q000473:pathology*; D004396:Coloring Agents; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000473:pathology; D016037:Single-Blind Method
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine