UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Poster

Standard Poster

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

UPPER GASTROINTESTINAL SURVEILLANCE IN LYNCH SYNDROME

Katrin van Beekum 1, Christoph Engel 2, Jacob Nattermann 1, Robert Hüneburg 1

Affiliations

1 University Hospital Bonn, Bonn, Germany|||University Hospital Bonn, Bonn, Germany

2 University of Leipzig, Leipzig, Germany

Summary

AI Generated

Retrospective study of 349 Lynch syndrome patients found that push enteroscopy detected jejunal neoplasia not visible on standard upper endoscopy, with clinically relevant findings in 50% of patients overall.

In 349 Lynch syndrome patients undergoing 960 endoscopic procedures, push enteroscopy exclusively detected jejunal adenomas in 2% of patients and jejunal cancer in 0.6%, while standard esophagogastroduodenoscopy detected none.
Clinically relevant findings occurred in 50% of patients, including gastric adenomas in 3.7%, gastric cancer in 1.1%, duodenal adenomas in 3.7%, duodenal cancer in 0.9%, and intestinal metaplasia in 28%.
In a separate cohort of 2859 Lynch syndrome patients from the German Consortium for Familial Intestinal Cancer, gastric cancer occurred in 2.2%, duodenal cancer in 2.1%, and jejunal cancer in 1.9%, predominantly in high-risk pathogenic variant carriers of MLH1, MSH2, and EPCAM.
The authors conclude that push enteroscopy should be considered in high-risk Lynch syndrome surveillance protocols due to its diagnostic value beyond conventional esophagogastroduodenoscopy.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Lynch syndrome (LS) is associated with an increased risk of upper gastrointestinal (GI) cancers. While upper GI surveillance is recommended in several guidelines, there remains international variability and ongoing debate regarding its implementation, timing, and extent. This study evaluated the incidence of gastric (GC), duodenal (DC), and jejunal cancers (JC) in LS patients using data from the German Consortium for Familial Intestinal Cancer (GCFIC). In addition, the diagnostic yield of esophagogastroduodenoscopy (EGD) and push enteroscopy (PE), performed at a tertiary care center, was retrospectively analyzed.

Aims & Methods

A total of 960 endoscopic procedures (494 EGD, 466 PE) were retrospectively analyzed in 349 LS patients documented at a tertiary care center. Push enteroscopy (PE) was performed using a colonoscope to allow deeper insertion into the small intestine, enabling inspection of the proximal jejunum. Clinically relevant findings included intestinal metaplasia, Barrett’s esophagus, adenomas, and carcinomas. These findings were systematically compared between EGD and PE to evaluate diagnostic yield. The GCFIC database was evaluated to determine cancer incidence by genotype.

Results

In the GCFIC cohort (n=2859), the majority of GC (2.2%), DC (2.1%), and JC (1.9%) occurred in high-risk pathogenic variant carriers (PGV) (MLH1, MSH2, EPCAM). However, a small proportion of cancers was also observed in low-risk PGV carriers: GC in two MSH6 carriers, DC in five patients with MSH6 or PMS2, and JC in seven low-risk carriers (MSH6: 3, PMS2: 4). In the NZET cohort, 22% of procedures and 50 % of patients revealed relevant findings. Gastric adenomas were found in 3.7%, gastric cancer in 1.1%, and intestinal metaplasia in 28% of patients. Duodenal adenomas were found in 3.7% and cancer in 0.9%. Jejunal neoplasia was detected exclusively by PE (adenomas 1.7%, cancer 0.6%).

	EGD (n= 499)		PE (n= 468)		all examinations (n= 964)		per patient (n= 349)		p- value	significant (p < 0.05)
Intestinal metaplasia	54	10.9%	78	16.7%	132	13.8%	98	28.1%	0.014	yes
Gastric adenoma	7	1.4%	4	0.9%	11	1.1%	9	2.6%	0.529	no
Dysplastic fundic gland	1	0.2%	3	0.6%	4	0.4%	4	1.1%
Gastric cancer	4	0.8%	0	0%	4	0.4%	4	1.1%
Duodenal adenoma	8	1.6%	7	1.5%	15	1.6%	13	3.7%	0.828	no
Duodenal cancer	2	0.4%	1	0.2%	3	0.3%	3	0.9%
Jejunal adenoma	0	0%	7	1.7%	8	0.8%	7	2%
Jejunal cancer	0	0%	2	0.4%	2	0.2%	2	0.6%
Clincally relevant findings	92	19%	118	25%	209	22%	175	50.1%	0.02	yes

Conclusion

Upper gastrointestinal surveillance is essential in patients with Lynch syndrome. Push enteroscopy (PE) provides diagnostic value beyond conventional esophagogastroduodenoscopy (EGD), particularly in detecting jejunal neoplasia, and should be considered in high-risk surveillance protocols.

Disclosure

Robert Hüneburg was funded by Deutsche Krebshilfe (DECADE), and Wilhelm-Sander-Stiftung.
Jacob Nattermann was funded by Wilhelm-Sander-Stiftung.

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

Oesophageal and gastric cancer: Diagnostic challenges (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

ESOPHAGEAL FUNCTION TESTING IDENTIFIES ASYMPTOMATIC BARRETT’S ESOPHAGUS PATIENTS WITH PATHOLOGICAL ACID EXPOSURE AT RISK FOR NEOPLASIA: A MULTICENTER STUDY

Elisa Marabotto

EMR or ESD for duodenal adenoma: Too much recurrence and too much risk?

Naohisa Yahagi

The dynamic liver macrophage niche in health and disease: Lessons from using intravital microscopy

Moritz Peiseler

GUT MICROBIOTA COMPOSITION AND ARTERIAL HYPERTENSION IN METABOLIC SYNDROME: THE ROLE OF ENTEROCLOSTER AND MICROBIALLY CONJUGATED BILE ACIDS

Angela Fulvia Tricase

A RARE CASE OF PSEUDOHEMATURIA INDUCED BY MESALAZINE

Helena Vasconcelos

NOT ALWAYS MECKEL’S: THE ROLE OF GASTRIC HETEROTOPIA IN GASTROINTESTINAL BLEEDING

Patrícia Vaz Conde

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

ESOPHAGEAL FUNCTION TESTING IDENTIFIES ASYMPTOMATIC BARRETT’S ESOPHAGUS PATIENTS WITH PATHOLOGICAL ACID EXPOSURE AT RISK FOR NEOPLASIA: A MULTICENTER STUDY

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.