Clinically actionable findings on surveillance EGD in asymptomatic patients with Lynch syndrome

Background and aims Lynch syndrome (LS) predisposes to multiple cancers including gastric and small bowel. Data supporting esophagogastroduodenoscopy (EGD) surveillance in LS are limited. Our aim is to describe upper gastrointestinal (UGI) findings in asymptomatic LS patients undergoing EGD surveillance within a hereditary colorectal cancer registry. Methods Asymptomatic patients with LS who underwent >1 surveillance EGD were included. Demographics, genotype, and EGD findings were reviewed. The frequency of clinically actionable findings including neoplasia (cancer, adenomas), Barrett's esophagus (BE), H pylori, and hyperplastic polyps >5 mm were assessed. Results Three hundred twenty-three patients underwent 717 EGDs starting at a median age of 49.5 years. On average, each patient had 2 EGDs with an interval of 2.3 years between examinations. Clinically actionable findings were identified in 57 patients (17.6%). A total of 27.7% of findings were identified on baseline EGD and the remainder on surveillance EGD over an average of 3.5 years. Five asymptomatic patients (1.5%) had an UGI cancer detected during surveillance, all at early stage, including 1 patient each with BE-related esophageal adenocarcinoma, gastric neuroendocrine tumor, and gastric adenocarcinoma, and 2 patients with duodenal adenocarcinoma. Two cancers were found on baseline EGD and 3 on follow-up EGD. Conclusions Clinically actionable findings were found in approximately 1 in 6 asymptomatic patients with LS undergoing EGD surveillance. 5 patients (1.5%) were diagnosed with cancer, all detected at an early stage. These data suggest that both baseline and follow-up EGD surveillance are effective in detecting early stage UGI cancers in asymptomatic patients with LS.