The Role of Colonoscopy in the Management of Individuals with Lynch Syndrome: A Narrative Review

SIMPLE SUMMARY: The research is being suggested from the observation that the incidence of colorectal cancer in individuals with Lynch Syndrome did not entirely decrease as expected, despite the high quality colonscopies performed in the surveillance programs, according to current Guidelines. The authors would like to highlight that the factors responsible for these results are indipendent of both endoscopy surveillance and adherence to prevention programs of individuals affected by Lynch Syndrome. Probably, the peculiarity of carcinogenesis itself in Lynch Syndrome is responsible for the above mentioned unexpected decrease in incidence of colorectal cancer in individuals with Lynch Syndome. Therefore, rather than continuing to shorten the timing of endoscopic surveillance, other early diagnostic techniques and subsequent prevention strategies should be forecasted in order to allow a more effective and customized endoscopic surveillance of individuals with Lynch Syndome. ABSTRACT: The history of Lynch syndrome changed definitively in 2000, when a study published in Gastroenterology demonstrated a significant reduction in mortality among individuals with Lynch syndrome who undergo regular endoscopic surveillance. As a consequence of this clinical evidence, all scientific societies developed guidelines, which highlighted the role of colonoscopy in the management of Lynch syndrome, especially for individuals at high risk of colorectal cancer. Over the years, these guidelines were modified and updated. Specialized networks were developed in order to standardize endoscopic surveillance programs and evaluate all the clinical data retrieved by the results of colonoscopies performed for both the screening and the surveillance of individuals with Lynch syndrome. Recent data show that the impact of colonoscopy (with polypectomy) on the prevention of colorectal cancer in individuals with Lynch syndrome is less significant than previously thought. This narrative review summarizes the current discussion, the hypotheses elaborated and the algorithms depicted for the management of individuals with Lynch Syndrome on the basis of the recent data published in the literature.