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• W4200528189 abstract "We would like to thank Dr Jain et al1Jain A. Alimirah M. Stanich P.P. Upper GI tract screening in Lynch syndrome.Gastrointest Endosc. 2022; 95: 202Abstract Full Text Full Text PDF Scopus (1) Google Scholar for their interest in our article2Farha N, Hrabe J, Sleiman J, et al. Clinically actionable findings on surveillance EGD in asymptomatic patients with Lynch syndrome. Gastrointest Endosc. Epub 2021 Jul 9.Google Scholar and their recognition of the importance of our study demonstrating clinically actionable findings detected by upper (EGD) in asymptomatic patients with Lynch syndrome (LS). Although a baseline EGD is suggested between ages 30 and 40 years in patients with LS to assess for and treat Helicobacter pylori, if present, follow-up surveillance EGD is recommended only to be considered in “patients at high risk of gastric cancer” with Lynch syndrome.3National Comprehensive Cancer NetworkGenetic/Familial High-Risk Assessment: Colorectal 2020.https://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdfGoogle Scholar, 4Giardiello F.M. Allen J.I. Axilbund J.E. et al.Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on colorectal cancer.Gastroenterology. 2014; 147: 502-526Abstract Full Text Full Text PDF PubMed Scopus (273) Google Scholar, 5Vasen H.F. Blanco I. Aktan-Collan K. et al.Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts.Gut. 2013; 62: 812-823Crossref PubMed Scopus (504) Google Scholar, 6Syngal S. Brand R.E. Church J.M. et al.ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes.Am J Gastroenterol. 2015; 110: 223-263Crossref PubMed Scopus (762) Google Scholar, 7Monahan K.J. Bradshaw N. Dolwani S. et al.Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG).Gut. 2020; 69: 411-444Crossref PubMed Scopus (70) Google Scholar Small-bowel cancer is reported in 0.4% to 11% of patients with MSH2 and MLH1 pathogenic variants, respectively, and lower in patients with an MSH6 pathogenic variant.3National Comprehensive Cancer NetworkGenetic/Familial High-Risk Assessment: Colorectal 2020.https://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdfGoogle Scholar Up to 47% of small-bowel cancers occur in the duodenum and up to 33% in the jejunum.8Schulmann K. Brasch F.E. Kunstmann E. et al.HNPCC-associated small bowel cancer: clinical and molecular characteristics.Gastroenterology. 2005; 128: 590-599Abstract Full Text Full Text PDF PubMed Scopus (151) Google Scholar,9ten Kate G.L. Kleibeuker J.H. Nagengast F.M. et al.Is surveillance of the small bowel indicated for Lynch syndrome families?.Gut. 2007; 56: 1198-1201Crossref PubMed Scopus (62) Google Scholar Jain et al1Jain A. Alimirah M. Stanich P.P. Upper GI tract screening in Lynch syndrome.Gastrointest Endosc. 2022; 95: 202Abstract Full Text Full Text PDF Scopus (1) Google Scholar favor the use of push enteroscopy for upper endoscopic surveillance in LS based on adenomas being detected in the distal duodenum and proximal jejunum in 2 of 129 patients undergoing push enteroscopy. Although push enteroscopy gains access to the distal duodenum and proximal jejunum, the additional benefit beyond that of EGD in asymptomatic patients with LS has not been studied. A trial comparing EGD with push enteroscopy for the detection of distal duodenal and proximal jejunal neoplasia would determine the utility and comparative cost effectiveness of push enteroscopy versus EGD. Both authors disclosed no financial relationships. Upper GI tract screening in Lynch syndromeGastrointestinal EndoscopyVol. 95Issue 1PreviewWe appreciated the recent study by Farha et al1 reporting the high rate of actionable findings on EGD in their large series of patients with Lynch syndrome. This is an important addition to the literature that highlights the real-world benefit of screening upper endoscopy in Lynch syndrome. Full-Text PDF" @default.
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