Chromoendoscopic colonoscopy for detecting preneoplastic lesions in hereditary nonpolyposis colorectal cancer syndrome. |
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| Authors: | Thierry Lecomte Christophe Cellier Tchao Meatchi Jean Philippe Barbier Paul Henri Cugnenc Raymond Jian Pierre Laurent-Puig Bruno Landi |
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| Institution: | 4. Service de Chirurgie Digestive et Générale, Hôpital Européen Georges Pompidou, Paris, France;3. Service d’Anatomopathologie, Hôpital Européen Georges Pompidou, Paris, France;1. University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France;2. UMR 1071 Inserm/Université d’Auvergne, USC-INRA 2018, Microbes, Intestine, Inflammation et Susceptibility of the Host, Clermont-Ferrand, France;3. University Hospital Estaing, Radiology Department, Clermont-Ferrand, France;4. GM Clermont-Ferrand University and Medical Center, DRCI, Biostatistics Unit, Clermont-Ferrand, France;1. First Department of Medicine, Semmelweis University, Budapest, Hungary;2. Faculty of Health Sciences, Department of Clinical Studies, Semmelweis University, Budapest, Hungary;3. Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, Montreal, QC, Canada;1. Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy;2. Gastroenterolgy Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy;1. Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;2. Department of Gastroenterology, Cattinara Hospital, Trieste, Italy;1. Gastrointestinal Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” University Hospital, Milan, Italy;2. Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia;3. Division of Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant''Orsola-Malpighi, Bologna, Italy;4. General Pathology, Department of Biomedical and Clinical Sciences, “L.Sacco” University Hospital, Milan, Italy |
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| Abstract: | BACKGROUND & AIMS: In hereditary nonpolyposis colorectal cancer (HNPCC) syndrome, flat and small adenomas are particularly prone to malignant transformation but might be missed by standard colonoscopy. We prospectively studied the diagnostic yield of high-resolution colonoscopy coupled with chromoendoscopy for preneoplastic and neoplastic colorectal lesions in patients with HNPCC syndrome. METHODS: Thirty-six consecutive asymptomatic patients (mean age, 42 years) belonging to HNPCC families and receiving genetic counseling were enrolled in this prospective study. Colonoscopy was performed in 2 steps. Conventional colonoscopy was performed first, followed by a second colonoscopy with chromoendoscopy with indigo carmine (.4%) dye sprayed onto the entire proximal colon. RESULTS: Conventional colonoscopy identified 25 lesions (mean size, 4 +/- 3 mm) in 13 patients. Seven lesions, detected in 5 patients, were adenomas, 3 of which were located in the proximal colon. Chromoendoscopy identified additional 45 lesions (mean size, 3 +/- 1 mm) in 20 patients; most of these lesions were flat and hyperplastic. Eleven additional adenomas were detected in the proximal colon of 8 patients, and 8 of these 11 lesions were flat. The use of chromoendoscopy significantly increased the detection rate of adenomas in the proximal colon, from 3 of 33 patients to 10 of 33 patients (P = .045). CONCLUSION: Relative to conventional colonoscopy, high-resolution colonoscopy with chromoendoscopy markedly improves the detection of adenomas in patients with HNPCC syndrome and might help to prevent colorectal carcinoma in these patients with a very high risk of colorectal cancer. |
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