Detalle Publicación

White-light endoscopy is adequate for Lynch syndrome surveillance in a randomized and noninferiority study

Autores: Rivero-Sanchez, L. ; Arnau-Collell, C. ; Herrero, J. ; Remedios, D. ; Cubiella, J. ; Garcia-Cougil, M.; Alvarez, V. ; Albeniz, E. ; Calvo, P.; Gordillo, J.; Puig, I. ; Lopez-Vicente, J.; Huerta, A. ; Lopez-Ceron, M.; Salces, I. ; Penas, B. ; Parejo, S.; de Santiago, E. R. ; Herráiz Bayod, Maite; Carretero Ribón, Cristina; Gimeno-Garcia, A. Z. ; Saperas, E.; Alvarez-Urturi, C.; Moreira, R.; de Miguel, C. R. ; Ocana, T. ; Moreira, L. ; Carballal, S.; Sanchez, A. ; Jung, G. ; Castells, A.; Llach, J. ; Balaguer, F.; Pellise, M. (Autor de correspondencia)
Título de la revista: GASTROENTEROLOGY
ISSN: 0016-5085
Volumen: 158
Número: 4
Páginas: 895 - 904.e1
Fecha de publicación: 2020
BACKGROUND & AIMS: Dye-based pancolonic chromoendoscopy is recommended for colorectal cancer surveillance in patients with Lynch syndrome. However, there is scarce evidence to support its superiority to high-definition white-light endoscopy. We performed a prospective study assess whether in the hands of high detecting colonoscopists, high-definition, white-light endoscopy is noninferior to pancolonic chromoendoscopy for detection of adenomas in patients with Lynch syndrome. METHODS: We conducted a parallel controlled study, from July 2016 through January 2018 at 14 centers in Spain of adults with pathogenic germline variants in mismatch repair genes (60% women; mean age, 47 +/- 14 years) under surveillance. Patients were randomly assigned to groups that underwent high-definition white-light endoscopy (n = 128) or pancolonic chromoendoscopy (n = 128) evaluations by 24 colonoscopists who specialized in detection of colorectal lesions in high-risk patients for colorectal cancer. Adenoma detection rates (defined as the proportion of patients with at least 1 adenoma) were compared between groups, with a noninferiority margin (relative difference) of 15%. RESULTS: We found an important overlap of confidence intervals (CIs) and no significant difference in adenoma detection rates by pancolonic chromoendoscopy (34.4%; 95% CI 26.4%-43.3%) vs white-light endoscopy (28.1%; 95% CI 21.1%-36.4%; P = .28). However, pancolonic chromoendoscopy detected serrated lesions in a significantly higher proportion of patients (37.5%; 95% CI 29.5-46.1) than white-light endoscopy (23.4%; 95% CI 16.9-31.4; P = .01). However, there were no significant differences between groups in proportions of patients found to have serrated lesions of 5 mm or larger (9.4% vs 7.0%; P = .49), of proximal location (11.7% vs 10.2%; P = .68), or sessile serrated lesions (3.9% vs 5.5%; P = .55), respectively. Total procedure and withdrawal times with pancolonic chromoendoscopy (30.7 +/- 12.8 minutes and 18.3 +/- 7.6 minutes, respectively) were significantly longer than with white-light endoscopy (22.4 +/- 8.7 minutes and 13.5 +/- 5.6 minutes; P <.001). CONCLUSIONS: In a randomized parallel trial, we found that for Lynch syndrome surveillance, high-definition white-light endoscopy is not inferior to pancolonic chromoendoscopy if performed by experienced and dedicated endoscopists.