Although this study is not about FAP patients, it does show the reason for doctors to use the Capule endoscopy.
Capsule endoscopy identifies small-bowel neoplasia at a curative stage in asymptomatic Lynch mutation carriers Jean-Christophe Saurin, Centre Hospitalier Lyon Sud, Pierre Bénite, France
Systematic small-bowel examination using capsule endoscopy is an acceptable screening method for small-bowel adenocarcinoma (SBA) in asymptomatic patients with Lynch syndrome, says Professor Saurin.
He explains that SBA is usually diagnosed in patients aged between 39 and 49 years, and although a patient with Lynch syndrome is 100 times more likely to develop SBA than an individual in the general population, the tumor is almost always diagnosed at a late stage and with a bad prognosis.
Therefore, Professor Saurin and colleagues wanted to improve the diagnosis of SBA. They prospectively compared the number of small-bowel neoplasia diagnosed with capsule endoscopy (P2, P1 or P0 lesions), compared with a small-bowel CT scan with water enteroclysis (certain, uncertain or unrelated lesions), in asymptomatic Lynch mutation carriers.
A total of 35 consecutive patients (18 males; mean age of 47 years) without symptoms or anemia were recruited to the study. All patients had a known deleterious germline mutation involving the MLH1 (57% of patients), MLH2 (29%), MLH6 (11%) or PMS2 (3%) genes.
Capsule endoscopy detected abnormal images in three (8.6%) patients that were later confirmed as neoplasia: two low-grade adenomas and one T3N0M0 adenocarcinoma. Two neoplasias were identified as highly relevant images (P2 lesions) and histologically confirmed after surgery whereas one of the adenomas was identified as an image of uncertain relevance (P1 lesions, small polyps or fold thickening) and later confirmed upon endoscopy. Endoscopies for other images of uncertain relevance were negative in all cases.
The small-bowel CT scan with water enteroclysis suspected the adenocarcinoma but missed both cases of adenoma.
Professor Saurin said that capsule endoscopy appears to be superior to CT enteroclysis for identifying small-bowel neoplasia, but noted that both diagnostic procedures showed images of uncertain relevance that may lead to aggressive complementary investigations.
He also noted that the preferred frequency for screening, age at first examination, and specific subgroups to be screened remain to be determined by larger studies.
Nevertheless, he concluded, "Early or advanced small-bowel cancer neoplasia can be detected at a curative stage using capsule endoscopy screening of Lynch mutation carriers."
He added, "Our approach may improve the difficult management of these patients."
RESOURCE GastroSource
