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CC BY 4.0 · Endosc Int Open 2024; 12(07): E854-E860
DOI: 10.1055/a-2339-7152
Original article

Quality of endoscopic surveillance of Lynch syndrome patients in a Swedish cohort

Sophie Walton Bernstedt 
1   Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden (Ringgold ID: RIN27106)
2   Division of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden (Ringgold ID: RIN59562)
3   Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden (Ringgold ID: RIN59562)
,
Adrianna Haxhijaj
1   Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden (Ringgold ID: RIN27106)
,
Nigin Jamizadeh
4   Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden (Ringgold ID: RIN27106)
,
Jan Björk
2   Division of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden (Ringgold ID: RIN59562)
5   Hereditary Cancer, Medical Unit Breast Endocrine and Sarcoma Tumours, Karolinska University Hospital, Stockholm, Sweden (Ringgold ID: RIN59562)
,
Anna Andreasson
4   Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden (Ringgold ID: RIN27106)
,
Anna M Forsberg
6   Department of Medicine Solna, Karolinska Institute Clinical Epidemiology Division, Stockholm, Sweden (Ringgold ID: RIN571139)
,
Ann-Sofie Backman
1   Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden (Ringgold ID: RIN27106)
7   Gastroenterology Unit, Division of Medicine, Ersta Hospital, Stockholm, Sweden (Ringgold ID: RIN83223)
› Author AffiliationsSupported by: Cancerfonden
Supported by: Vetenskapsrådet
Supported by: Bengt Ihres Foundation
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Abstract

Background and study aims Risk factors for colorectal cancer (CRC) in Lynch syndrome (LS) include sex, age, smoking, high body mass index (BMI), surveillance interval length, and risk genotype. The Boston Bowel Preparation Scale (BBPS) produces a standardized bowel cleanliness rating. A low BBPS score might be a risk factor for missed early lesions. The aim of this study was to investigate the correlation between BBPS score and adenoma detection (with known risk factors for CRC) and surveillance interval with CRC detection in LS patients.

Methods A retrospective cohort study including 366 LS patients with 1,887 colonoscopies under surveillance in Stockholm, Sweden from 1989 to 2021 was conducted. Associations were tested using linear and logistic regression.

Results We found no association between BBPS score and number of adenomas detected. A low BBPS score was found to be associated with older age (regression coefficient (coeff) –0.015; 95% confidence interval [CI] –0.026 to –0.004; P = 0.007) and obesity (coeff = –0.48; 95% CI: –0.89 to –0.062; P = 0.024). A higher number of detected adenomas was associated with older age (coeff = 0.008; 95% CI 0.004 to 0.012; P < 0.001), male sex (coeff = 0.097; 95% CI 0.008 to 0.19; P = 0.033) and CRC (coeff = 0.28; 95% CI 0.061 to 0.50; P = 0.012). Surveillance interval length was not significant in CRC detection.

Conclusions Bowel cleanliness was not associated with adenoma detection and was less likely achieved in patients who were older and had higher BMI. Adenoma detection was associated with older age and male sex. The results indicate the need for better adherence to guidelines and attention to older age groups, men, and patients with obesity.

Keywords

Endoscopy Lower GI Tract - Polyps / adenomas / ... - Colorectal cancer - Quality and logistical aspects


Publication History

Received: 14 September 2023

Accepted after revision: 06 April 2024

Article published online:
04 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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