Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome

Endoscopy. 2010 Dec;42(12):1057-62. doi: 10.1055/s-0030-1255742. Epub 2010 Sep 6.


Background and study aims: Patients with Lynch syndrome are at increased risk of developing small-bowel adenocarcinoma, which usually has a bad prognosis and needs to be diagnosed early. Our aim was to evaluate the yield of capsule endoscopy and CT enteroclysis in this situation.

Patients and methods: We performed a prospective, blinded, comparative study of capsule endoscopy and CT enteroclysis in five academic centers. Thirty-five consecutive asymptomatic patients with Lynch syndrome, all with one proven deleterious mutation, were included. A double reading was performed blind for both types of examination.

Results: Histologically confirmed small-bowel neoplasms were diagnosed in three patients (8.6 %): one adenocarcinoma (T3N0M0) and two adenomas with low-grade dysplasia. Capsule endoscopy identified all neoplasms. CT enteroclysis raised suspicion of one neoplasm (adenocarcinoma) but missed the two others. Concordance between the two capsule readings was high with a κ value of 0.78 (95 %CI 0.55 to 1.0), which was not the case for CT enteroclysis, where the κ value was 0.15 (95 %CI -0.27 to 0.58).

Conclusion: Curable early or advanced neoplasms in asymptomatic patients with Lynch syndrome using capsule endoscopy can be detected with a better reproducibility than with CT enteroclysis. The clinical usefulness of systematic small-bowel screening in these patients should be confirmed through large prospective studies.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / diagnostic imaging
  • Adenoma / diagnosis*
  • Adenoma / diagnostic imaging
  • Adult
  • Aged
  • Capsule Endoscopy*
  • Colorectal Neoplasms, Hereditary Nonpolyposis / complications*
  • Contrast Media / administration & dosage
  • Female
  • Humans
  • Intestinal Neoplasms / diagnosis*
  • Intestinal Neoplasms / diagnostic imaging
  • Intestinal Neoplasms / etiology
  • Intestine, Small* / diagnostic imaging
  • Male
  • Middle Aged
  • Prospective Studies
  • Reproducibility of Results
  • Single-Blind Method
  • Tomography, X-Ray Computed


  • Contrast Media