HD white-light endoscopy offers alternative for Lynch syndrome surveillance
Endoscopic surveillance for Lynch syndrome using high-definition white-light endoscopy was noninferior to surveillance using pancolonic chromoendoscopy, according to study results.
Maria Pellisé, MD, PhD, of the department of gastroenterology at Hospital Clinic de Barcelona, and colleagues wrote that while chromoendoscopy recommended technique for Lynch syndrome surveillance, it can be labor-intensive and time consuming.
“Most of the studies that have compared pancolonic chromoendoscopy with white-light endoscopy were performed during the standard-definition era, had a reduced and heterogeneous population and more importantly, had a non-randomized back-to-back design,” they wrote. “We hypothesized that, in high-detector hands, high-definition white-light endoscopy would be as effective as pancolonic chromoendoscopy to detect adenomas.”
Researchers conducted a parallel controlled study comprising 256 patients under surveillance for Lynch syndrome (60% women; mean age, 47 ± 12 years). They randomly assigned patients to undergo colonoscopy with chromoendoscopy (n = 128) or high-definition white-light endoscopy (n = 128). They compared adenoma detection between the two groups with a non-inferiority margin of 15%.
Pellisé found no significant difference in adenoma rates between the groups using chromoendoscopy (34.4%; 95% CI, 26.4%–43.4%) and high-definition white-light endoscopy (28.1%; 95% CI, 21.1%–36.4%).
Although chromoendoscopy helped detect serrated polyps in a higher proportion of patients compared with high-definition white-light endoscopy, there was no significant differences between groups in the proportion of patients found to have serrated lesions 5 mm in size or larger (9.4% vs. 7%) or sessile serrated lesions (3.9% vs. 5.5%).
Colonoscopies that used high-definition white-light endoscopy had shorter total procedure times (22.4 ± 8.7 minutes) and withdrawal time (13.5 ± 5.6 minutes) compared with colonoscopies that used chromoendoscopy (30.7 ± 12.8 minutes and 18.3 ± 7.6 minutes, respectively).
“For surveillance of individuals with Lynch syndrome, high-definition white-light endoscopy is not inferior to pancolonic chromoendoscopy if performed by experienced and dedicated endoscopists,” Pellisé and colleagues wrote. “However, our results do not permit to state that pancolonic chromoendoscopy should be replaced by white-light endoscopy in low-detector hands or when only standard-definition technology is available.” – by Alex Young
Disclosures: Pellisé reports receiving a research grant from Fujifilm, consulting fees from Norgine, speakers’ fees from Casen Recordati, Janssen, Norgine and Olympus, and an editorial fee from Thieme. Please see the full study for all other authors’ relevant financial disclosures.