P2508 - Clinically Actionable Findings on Surveillance EGD in Asymptomatic Patients With Lynch Syndrome

Natalie Farha, MD¹, Jennifer Hrabe, MD², Joseph Sleiman, MD¹, Jonathan Beard, MD¹, Ruishen Lyu, BS¹, Amit Bhatt, MD³, James Church, MD¹, Lisa LaGuardia, BSN¹, Brandie Leach, ¹, David Liska, MD¹, Gautam Mankaney, MD⁴, Susan Milicia, BSN¹, Margaret O'Malley, BS¹, Matthew Kalady, MD⁵, Carol A. Burke, MD^1
1Cleveland Clinic Foundation, Cleveland, OH; ²University of Iowa, Iowa City, IA; ³Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH; ⁴Virginia Mason Medical Center, Lynnwood, WA; ⁵The Ohio State University, Columbus, OH

Introduction: There is a paucity of data supporting esophago-gastro-duodenoscopy (EGD) surveillance in patients with Lynch Syndrome (LS). Published guidelines suggest consideration of baseline EGD with testing and treatment for H pylori if present; however, no consensus is reached for ongoing EGD surveillance. In the last two years, some data suggesting the benefit of EGD surveillance has been published, but more evidence is needed. Our aim was to contribute to this growing body of evidence by assessing the prevalence of clinically actionable findings (CAF) in a cohort of asymptomatic patients with LS undergoing EGD surveillance.

Methods: We undertook a retrospective review of a prospectively maintained database of patients with LS. Asymptomatic patients who underwent > 1 surveillance EGD were included. Demographics, genotype, and EGD findings were reviewed. CAF, defined as neoplasia (adenomas, cancer) and other findings requiring treatment or surveillance were reported. These include Barrett’s esophagus, H. pylori, fundic gland polyps with high-grade dysplasia, pyloric gland adenomas, tubular adenomas, tubulovillous adenomas, villous adenomas, hyperplastic polyps >5mm, and esophageal, gastric, or duodenal cancer.

Results: 323 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 exams. 65 CAF were identified in 57 patients (17.6%). 22.7% of CAF were identified on baseline EGD and the remaining 77.3% on surveillance (Table 1). 5 asymptomatic patients (1.5%) had an UGI cancer detected during surveillance, all at early stage, including one patient each with BE-related esophageal adenocarcinoma, gastric neuroendocrine tumor, and gastric adenocarcinoma, and two patients with duodenal adenocarcinoma. Four patients had an MSH2 PV and 1 had an MLH1 PV. Two cancers were found on baseline and three on follow-up EGD.

Discussion: CAF were found in approximately 1 in 6 asymptomatic patients with LS undergoing EGD surveillance including 1.5% with UGI cancer, all detected at early stage. Our study is novel by demonstrating the utility of both baseline and follow-up surveillance EGD, whereupon the majority of CAF were found. Given that the rate of complications and expense of EGD are low, the prevalence and incidence of CAF on surveillance EGD is high, and the stage benefit associated with surveillance detected UGI cancer is favorable, we believe EGD surveillance is warranted in all patients with LS until more data is available.

Finding	Overall Number of Patients (%) N = 323	Baseline EGD Number of Patients (%) N = 323	Follow-up EGD Number of Patients (%) N = 184
Esophagus
Barrett’s Esophagus With Low Grade Dysplasia (LGD) With High Grade Dysplasia (HGD)	21 (6.5) 1 (0.3) 1 (0.3)	12 (3.7) 0 (0.0) 1 (0.3)	9 (4.9) 1 (0.5) 0 (0.0)
Esophageal Adenocarcinoma	1 (0.3)	0 (0.0)	1 (0.5)
Stomach
H pylori positive Number tested = 261/323	10 (3.8)
Gastric intestinal metaplasia (GIM) Number tested = 261/323	15 (5.7)
Fundic Gland Polyp (FGP) FGP with LGD FGP with HGD	50 (15.5) 6 (1.8) 0 (0.0)	28 (8.7) 3 (0.9) 0 (0.0)	22 (12.0) 3 (0.9) 0 (0.0)
Fundic Gland Polyp (FGP) 1-20 FGP > 20 FGP	48 (14.9) 2 (0.6)	26 (8.0) 2 (0.6)	22 (11.9) 0 (0.0)
Pyloric Gland Adenoma with LGD Pyloric Gland Adenoma with HGD	1 (0.3) 1 (0.3)	0 (0.0) 0 (0.0)	1 (0.5) 1 (0.5)
Hyperplastic polyp > 5mm	6 (1.9)	1 (0.3)	5 (2.7)
Tubular Adenoma with HGD	1 (0.3)	1 (0.3)	0 (0.0)
Gastric Adenocarcinoma	1 (0.3)	1 (0.3)	0 (0.0)
Gastric Neuroendocrine tumor	1 (0.3)	0 (0.0)	1 (0.5)
Duodenum
Duodenal adenoma Tubular Adenoma Tubular Adenoma with HGD Tubulovillous Adenoma	5 (1.5) 3 (0.9) 1 (0.3) 1 (0.3)	2 (0.6) 1 (0.3) 1 (0.3) 0 (0.0)	3 (1.6) 2 (1.1) 0 (0.0) 1 (0.5)
Adenocarcinoma	2 (0.6)	1 (0.3)	1 (0.5)

Table: Title: Table 1: Clinical and Pathologic Findings on EGD
Abbreviations: EGD = esophago-gastro-duodenoscopy; LGD = low grade dysplasia; HGD = high grade dysplasia; FGP = fundic gland polyp; GIM = gastric intestinal metaplasia


Disclosures:
Natalie Farha indicated no relevant financial relationships.
Jennifer Hrabe indicated no relevant financial relationships.
Joseph Sleiman indicated no relevant financial relationships.
Jonathan Beard indicated no relevant financial relationships.
Ruishen Lyu indicated no relevant financial relationships.
Amit Bhatt indicated no relevant financial relationships.
James Church indicated no relevant financial relationships.
Lisa LaGuardia indicated no relevant financial relationships.
Brandie Leach indicated no relevant financial relationships.
David Liska indicated no relevant financial relationships.
Gautam Mankaney indicated no relevant financial relationships.
Susan Milicia indicated no relevant financial relationships.
Margaret O''Malley indicated no relevant financial relationships.
Matthew Kalady indicated no relevant financial relationships.
Carol Burke indicated no relevant financial relationships.


Natalie Farha, MD¹, Jennifer Hrabe, MD², Joseph Sleiman, MD¹, Jonathan Beard, MD¹, Ruishen Lyu, BS¹, Amit Bhatt, MD³, James Church, MD¹, Lisa LaGuardia, BSN¹, Brandie Leach, ¹, David Liska, MD¹, Gautam Mankaney, MD⁴, Susan Milicia, BSN¹, Margaret O'Malley, BS¹, Matthew Kalady, MD⁵, Carol A. Burke, MD¹. P2508 - Clinically Actionable Findings on Surveillance EGD in Asymptomatic Patients With Lynch Syndrome, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.