Original articleChromoendoscopic Colonoscopy for Detecting Preneoplastic Lesions in Hereditary Nonpolyposis Colorectal Cancer Syndrome
Section snippets
Patients
The International Collaborative Group on HNPCC recommends that patients meeting the Amsterdam criteria and/or with a mutated germinal mismatch repair (MMR) gene undergo colonoscopy every 2 years, starting at the age of 25 years.6 We conducted a prospective study of consecutive asymptomatic individuals belonging to families meeting the Amsterdam criteria for HNPCC syndrome. The patients received genetic counseling and were referred for colonoscopy after giving their informed consent, in keeping
Results
A total of 36 patients met the inclusion criteria and were enrolled in the study between April 2001 and June 2003. None of the screened patients declined to take part in the study.
The baseline characteristics of the 36 patients are shown in Table 1. Eighteen patients included in our study had a confirmed germline MMR gene mutation. Among them, 12 patients had a germline mutation of MSH2 gene and 6 a germline mutation of MLH1 gene. No germline MMR gene mutation was detected in the 18 other
Discussion
This study shows that chromoendoscopy with indigo carmine significantly improves the detection of preneoplastic adenomatous lesions in the proximal colon of patients with HNPCC syndrome. In the largest series of HNPCC families participating in a surveillance program, colonoscopic screening at 3-year intervals has reduced the colorectal cancer rate by at least 60%, prevented colorectal cancer deaths, and reduced overall mortality by about 65%.3 However, colorectal cancer can occur with a few
References (31)
- et al.
Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer
Gastroenterology
(2000) - et al.
Screening reduces colorectal cancer rate in families with hereditary nonpolyposis colorectal cancer
Gastroenterology
(1995) - et al.
Colorectal cancer screening and surveillanceclinical guidelines and rationale-update based on new evidence
Gastroenterology
(2003) - et al.
Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy
Gastrointest Endosc
(1995) - et al.
Flat and depressed colonic neoplasmsa prospective study of 1000 colonoscopies in the UK
Lancet
(2000) - et al.
Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopya randomized controlled trial
Gastrointest Endosc
(2002) - et al.
Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis
Gastroenterology
(2003) - et al.
Colonoscopic management of focal and early colorectal carcinoma
Baillieres Clin Gastroenterol
(1989) - et al.
Hereditary nonpolyposis colorectal cancerresults of long-term surveillance in 50 families
Eur J Cancer
(1995) - et al.
Interval cancers in hereditary non-polyposis colorectal cancer (Lynch syndrome)
Lancet
(1995)