Colonoscopy in Patients with Lynch Syndrome: What Is the Best Imaging Modality?

Patients with Lynch syndrome (LS) are at high risk for colorectal cancer (CRC) and should undergo intensive surveillance with colonoscopy. European guidelines recommend high-definition colonoscopy with dye-based or electronic chromoendoscopy (Endoscopy 2014; 46:435), but this recommendation is based on low-quality evidence, and dye-based chromoendoscopy is not popular. Two recent studies were conducted to determine the best colonoscopic imaging modality in LS patients.

In the first, 138 LS patients underwent back-to-back colonoscopies, first with narrow-band imaging (NBI) and followed by dye-based chromoendoscopy. The adenoma detection rate (ADR) of NBI alone was 20.3% versus 30.4% after both modalities; the 10.1% difference did not meet the…