The following is the summary of “Approach to Performance of Quality Upper Endoscopy in Lynch Syndrome (QUELS)” published in the January 2023 issue of Gastroenterology by Farha, et al.
Lynch syndrome (LS) patients concerned about their risk of developing colorectal cancer should have regular colonoscopies, a practice supported by several guidelines and backed by strong evidence. Evidence for the effectiveness of upper endoscopy [esophagogastroduodenoscopy (EGD)] in the surveillance of upper gastrointestinal (UGI) cancer has been scant until recently. However, several studies in the last 3 years have linked EGD surveillance in LS to the early diagnosis of precancerous lesions and UGI malignancies in their early stages.
The 2022 National Comprehensive Cancer Network (NCCN) Guidelines for LS recommend UGI surveillance with EGD beginning between the ages of 30 and 40, with repeat EGDs every 2 to 4 years, preferably in conjunction with colonoscopy, in all patients with a germline pathogenic variant (PV) in MLH1, MSH2, EPCAM, and MSH6 and, due to a lack of data, consideration in PMS2. To better understand the cost-effectiveness and outcomes of patients having EGD as a surveillance tool, it is necessary to standardize the approach to performing EGD surveillance in LS and reporting clinically meaningful data.
By providing new quality measurements, this Quality of Upper Endoscopy in Lynch Syndrome (QUELS) statement aims to establish a common methodology for performing and reporting EGD findings in patients with LS. The proposed recommendations provide a practical strategy for doctors using EGD surveillance in compliance with the most recent and existing LS guidelines, and were established based on available research and consensus-based expert opinion.