Colorectal cancer screening in Lynch syndrome: Indication, techniques and future perspectives.

Lynch syndrome (LS) is an inherited predisposition to colorectal cancer (CRC), responsible for 3-5% of all CRC. This syndrome is characterized by the early occurrence of colorectal neoplastic lesions, with variable incidences depending on the type of pathogenic variants in MMR genes (MLH1, MSH2, MSH6, PMS2 and EPCAM) and demographics factors such as gender, body mass index, tobacco use and physical activity. Similar to sporadic cancers, colorectal screening by colonoscopy is efficient because it is associated with a reduction >50% of both CRC incidence and CRC related mortality. To that end, most guidelines recommend high definition screening colonoscopies in dedicated centers, starting at the age of 20-25 years old, with a surveillance interval of 1-2 years. In this review, we discuss the importance of high definition colonoscopies, including the compliance to specific key performance indicators, as well as the expected benefits of specific imaging modalities including virtual chromoendoscopy and dye-spray chromoendoscopy.

The Iatrogenic Complications of Colonoscopic Polypectomy: A Multicenter Retrospective Study

BACKGROUND/AIMS: Colonoscopic polypectomy is an effective tool for the treatment of colonic polyps. With the recent widespread use of colonoscopic polypectomy, there is a growing concern about iatrogenic complications, such as bleeding and perforation. The aim of this study is to analyze the clinical presentation and management of complications during colonoscopic polypectomy. METHODS: We retrospectively reviewed the medical records of colonoscopic examinations performed at 5 hospitals of Hallym University Medical Center between June 2005 and June 2008. RESULTS: A total of 26,773 colonoscopies and 4,123 colonoscopic polypectomy were performed. The overall rate of complication was 1.04% (43/4,123). Perforation occurred in 0.19% (8/4,123) of cases, and bleeding occurred in 0.85% (35/4,123) of cases. Perforation occurred in 0.05% of snare polypectomies, 1.09% of endoscopic mucosal resections (EMR), and 7.14% of endoscopic submucosal dissections (ESD). Bleeding occurred in 0.8% of snare polypectomies, 1.09% of EMRs, and 3.57% of ESDs. The complication rate of ESDs was higher than in EMRs and snare polypectomies (P<0.001). Endoscopic clippings were performed in 25% of perforation and 66.7% of bleeding cases. Medical treatment was successful in 75% of perforation and 100% of bleeding cases. CONCLUSIONS: Colonoscopic polypectomy is a safe procedure for the treatment of colonic polyps, but rarely, serious complications occur. Compared to a snare polypectomy or an EMR, the complication of an ESD occurs more frequently. Endoscopic treatment and further conservative management seems to be appropriate in most cases with complication.

Pneumatosis coli / 대한내과학회지

No abstract available.