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Endosc Int Open 2016; 04(12): E1305-E1310
DOI: 10.1055/s-0042-112582
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Chromoendoscopy in combination with random biopsies does not improve detection of gastric cancer foci in CDH1 mutation positive patients

Robert Hüneburg   *
1   Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Tim Marwitz   *
1   Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
,
Peer van Heteren
1   Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Tobias J. Weismüller
1   Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Jonel Trebicka
1   Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
,
Ronja Adam
2   Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Stefan Aretz
2   Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Alberto Perez Bouza
3   Institute of Pathology, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Dimitrios Pantelis
4   Department of Surgery, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Jörg C. Kalff
4   Department of Surgery, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Jacob Nattermann   *
1   Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
,
Cristian P. Strassburg   *
1   Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
5   Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
› Author Affiliations
Further Information

Publication History

submitted 06 January 2016

accepted after revision 13 June 2016

Publication Date:
31 August 2016 (online)

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Comment on:

Endoscopy International Open – recently publishedEndoscopy 2017; 49(01): 97-97
DOI: 10.1055/s-0042-120942

Background and study aims: Hereditary diffuse gastric cancer (HGGC), an autosomal dominant tumor-syndrome, accounts for 1 % to 3 % of gastric cancers worldwide. Presumably 30 % to 40 % of all patients fulfilling the clinical guidelines for HDGC are carriers of a pathogenic mutation in the CDH1 gene. Patients often show multiple foci of signet ring cell carcinoma at early age and are advised to undergo prophylactic total gastrectomy (PTG). Our aim was to improve the endoscopic detection of HDGC by using an enhanced endoscopic protocol.

Patient and methods: Patients with a proven CDH1 germline mutation identified in our institute were prospectively included. Patients were advised to undergo PTG and offered a baseline endoscopic examination prior surgery. Examination was performed by using high-resolution white-light endoscopy and pan-gastric chromoendoscopy with indigo carmine as dye combined with targeted and multiple random biopsies assessed by an expert histopathologist. Postoperative histopathology was compared with results from endoscopic biopsies.

Results: Between September 2012 and November 2014 8 patients with a proven CDH1 germline mutation were included. We conducted 44 targeted (6.3/patient) and 225 random (32.1/patient) biopsies in 7 patients. We detected 1 gastric cancer by random biopsy (14 %). All other examinations showed no signs of cancer.

Histopathology of gastrectomy specimen revealed multiple foci of gastric carcinoma in 6 patients (86 %) with a total number of 27 cancer foci.

Conclusions: Examination with targeted and random biopsies combined with chromoendoscopy is not able to detect small foci of gastric cancer in CDH1 mutation carriers. Therefore PTG is advocated in these patients.

* Drs. Hüneburg and Marwitz contributed equally and Dr. Strassburg shared senior authorship with Dr. Nattermann.


 

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