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Value of upper gastrointestinal endoscopy for gastric cancer surveillance in patients with Lynch syndrome
Authors:Swetlana Ladigan‐Badura  Deepak B Vangala  Christoph Engel  Karolin Bucksch  Robert Hueneburg  Claudia Perne  Jacob Nattermann  Verena Steinke‐Lange  Nils Rahner  Hans K Schackert  Jürgen Weitz  Matthias Kloor  Judith Kuhlkamp  Huu Phuc Nguyen  Gabriela Moeslein  Christian Strassburg  Monika Morak  Elke Holinski‐Feder  Reinhard Buettner  Stefan Aretz  Markus Loeffler  Wolff Schmiegel  Christian Pox  Karsten Schulmann  
Abstract:In our study, we evaluated the effectiveness of upper gastrointestinal (GI) endoscopy as an instrument for early gastric cancer (GC) detection in Lynch syndrome (LS) patients by analyzing data from the registry of the German Consortium for Familial Intestinal Cancer. In a prospective, multicenter cohort study, 1128 out of 2009 registered individuals with confirmed LS underwent 5176 upper GI endoscopies. Compliance was good since 77.6% of upper GI endoscopies were completed within the recommended interval of 1 to 3 years. Forty‐nine GC events were observed in 47 patients. MLH1 (n = 21) and MSH2 (n = 24) mutations were the most prevalent. GCs in patients undergoing regular surveillance were diagnosed significantly more often in an early‐stage disease (UICC I) than GCs detected through symptoms (83% vs 25%; P = .0231). Thirty‐two (68%) patients had a negative family history of GC. The median age at diagnosis was 51 years (range 28‐66). Of all GC patients, 13 were diagnosed at an age younger than 45. Our study supports the recommendation of regular upper GI endoscopy surveillance for LS patients beginning no later than at the age of 30.
Keywords:gastric cancer  HNPCC  Lynch syndrome  screening  surveillance
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