Endoscopic management of Lynch syndrome and of familial risk of colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

van Leerdam ME1,2, Roos VH3, van Hooft JE3, Balaguer F4,5, Dekker E3, Kaminski MF6,7,8, Latchford A9,10, Neumann H11, Ricciardiello L12, Rupińska M6,7, Saurin JC13, Tanis PJ14, Wagner A15, Jover R16, Pellisé M4,5.

Author information

1: Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
2: Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands, Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands.
3: Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
4: Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
5: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
6: Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
7: Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.
8: Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
9: Polyposis Registry, St. Mark's Hospital, Harrow, United Kingdom.
10: Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
11: Department of Medicine I, University Medical Center Mainz, Mainz, Germany.
12: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
13: Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France.
14: Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, , Amsterdam, The Netherlands.
15: Department of Clinical Genetics, Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
16: Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain.

Abstract

ESGE recommends that individuals with Lynch syndrome should be followed in dedicated units that practice monitoring of compliance and endoscopic performance measures.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends starting colonoscopy surveillance at the age of 25 years for MLH1 and MSH2 mutation carriers and at the age of 35 years for MSH6 and PMS2 mutation carriers.Strong recommendation, moderate quality evidence, level of agreement 100 %. ESGE recommends the routine use of high-definition endoscopy systems in individuals with Lynch syndrome. Strong recommendation, high quality evidence, level of agreement 100 %. ESGE suggests the use of chromoendoscopy may be of benefit in individuals with Lynch syndrome undergoing colonoscopy; however routine use must be balanced against costs, training, and practical considerations.Weak recommendation, moderate quality evidence, level of agreement 89 %.ESGE recommends definition of familial risk of colorectal cancer as the presence of at least two first-degree relatives with colorectal cancer or at least one first-degree relative with colorectal cancer before the age of 50 years.Strong recommendation, moderate quality evidence, level of agreement 92 %.ESGE recommends colonoscopy surveillance in first-degree relatives of colorectal cancer patients in families that fulfill the definition of familial risk of colorectal cancer.Strong recommendation, moderate quality evidence, level of agreement 100 %.