- 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.
- 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.