PT  - JOURNAL ARTICLE
AU  - Jasmijn F Haanstra
AU  - Abdul Al-Toma
AU  - Evelien Dekker
AU  - Steven A L W Vanhoutvin
AU  - Fokko M Nagengast
AU  - Elisabeth M Mathus-Vliegen
AU  - Monique E van Leerdam
AU  - Wouter H de Vos tot Nederveen Cappel
AU  - Silvia Sanduleanu
AU  - Roeland A Veenendaal
AU  - Annemieke Cats
AU  - Hans F A Vasen
AU  - Jan H Kleibeuker
AU  - Jan J Koornstra
TI  - Prevalence of small-bowel neoplasia in Lynch syndrome assessed by video capsule endoscopy
AID  - 10.1136/gutjnl-2014-307348
DP  - 2015 Oct 01
TA  - Gut
PG  - 1578--1583
VI  - 64
IP  - 10
4099  - http://gut.bmj.com/content/64/10/1578.short
4100  - http://gut.bmj.com/content/64/10/1578.full
SO  - Gut2015 Oct 01; 64
AB  - Objective The aim was to determine the prevalence of small-bowel neoplasia in asymptomatic patients with Lynch syndrome (LS) by video capsule endoscopy (VCE).Design 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.Trial registration number NCT00898768.