GI Endoscopy · 2 min read
Gastric Adenoma Resection in a Patient with Lynch Syndrome
Experienced teaching points
Clinical Pearls
- Lynch syndrome predisposes patients to gastric adenocarcinoma, most often intestinal-type.
- ACG guidance supports considering EGD with gastric biopsy starting at ages 30 to 35, with H. pylori treatment if present.
- Surveillance EGDs can catch precancerous gastric adenomas early enough for endoscopic resection.
- Hot EMR with lifting agent and clip closure is an effective approach for selected flat fundic adenomas.
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| Patient: | 49-year-old male with Lynch syndrome |
| Indication: | Routine screening colonoscopy and EGD |
| Final diagnosis: | Gastric adenoma, intestinal type, with low-grade dysplasia, resected by EMR |
Endoscopic Findings
- EGD demonstrated a 20 mm flat polypoid lesion in the gastric fundus.
- The remainder of the examined upper GI tract showed no additional suspicious gastric lesions at this examination.
Endoscopic Technique
- The fundic lesion was lifted with Eleview injection.
- Hot endoscopic mucosal resection (EMR) was performed.
- The resection site was closed with endoscopic clips.
- Histology showed gastric adenoma, intestinal type, with low-grade dysplasia. Testing was negative for Helicobacter pylori.
Discussion
Lynch syndrome is the most common hereditary cancer predisposition syndrome. It is caused by autosomal dominant germline pathogenic variants in DNA mismatch repair genes and substantially increases lifetime risk of multiple cancers, most notably colorectal cancer (40 to 80%) and endometrial cancer (40 to 60%). Gastric cancer risk ranges from about 0.2 to 13% depending on the gene involved, and intestinal-type gastric adenocarcinoma is the usual histology.
Current ACG guidance recommends colonoscopy at least every two years in people with or at risk for Lynch syndrome. It also recommends considering EGD with gastric biopsy beginning at ages 30 to 35, treating H. pylori if detected, and continuing surveillance every 3 to 5 years when there is a family history of gastric or duodenal cancer.
This case shows why surveillance EGD matters in Lynch syndrome: a flat fundic adenoma with low-grade dysplasia was identified and removed endoscopically before progression to invasive adenocarcinoma.
References
- Kastrinos F, et al. The American College of Gastroenterology Clinical Guideline: Genetic Predisposition to Gastrointestinal Cancers. Am J Gastroenterol. 2021;116(11):2100-2122.
- Ladep NG, et al. Gastric cancer surveillance in Lynch syndrome: A systematic review. Fam Cancer. 2018;17(3):477-486.
- Pimentel-Nunes P, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for gastric epithelial neoplasia: an ESGE Guideline. Endoscopy. 2015;47(9):829-856.
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