Lynch syndrome: European guidelines for CRC surveillance

  • van Leerdam ME & al.
  • Endoscopy
  • 9 Oct 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • The European Society of Gastrointestinal Endoscopy (ESGE) has issued a new guideline for endoscopic management and colorectal cancer (CRC) risk assessment in patients with Lynch syndrome.

Why this matters

  • Lynch syndrome is associated with a 15%-70% risk for CRC by age 70 years.

Key points

  • Facilities/equipment:
    • Surveillance in dedicated units that monitor compliance and endoscopic performance measures.
    • High-definition endoscopy systems should be used.
    • Chromoendoscopy may be useful during colonoscopy, but its benefits must be weighed against costs, training, and practical considerations. 
  • Surveillance timing:
    • Asymptomatic individuals with Lynch syndrome should undergo surveillance every 2 years.
    • MLH1 and MSH2 mutation carriers should begin endoscopy at age 25 years, while MSH6 and PMS2 carriers should start at age 35 years.
  • Familial risk:
    • An individual should be considered to be at familial risk for CRC if ≥2 first-degree relatives have had CRC or ≥1 have had CRC at age
    • In families considered to be at familial risk, colonoscopy surveillance should be performed in first-degree relatives of any CRC patient.
    • A 5-year surveillance interval is recommended following a normal high-quality baseline examination in high-risk families.
    • Follow-up after polyp excision should follow general population guidelines.