Yield of repeat gastric biopsies and Helicobacter pylori serological assessment in Lynch syndrome.

BACKGROUND: Upper gastrointestinal surveillance in Lynch syndrome (LS) remains an ongoing debate; some guidelines recommend upper endoscopy with non-targeted biopsies of the gastric antrum/body to detect Helicobacter pylori (HP) and/or gastric intestinal metaplasia (GIM). However, whether non-targeted gastric biopsies should be repeated on successive upper endoscopies remains uncertain. Therefore, we aimed to determine the yield of repeat non-targeted gastric antrum/body biopsies and assess the HP seropositivity of a LS cohort. METHODS: Clinical and pathology data were collected retrospectively from LS carriers who underwent upper endoscopy with non-targeted gastric biopsies. Plasma samples from a LS biobank were tested for HP IgG positivity. RESULTS: Amongst 683 LS carriers, there were 291 (43 %) with 1+, 145 (21 %) with 2+, and 45 (7 %) with 3+ upper endoscopies with non-targeted gastric antrum and body biopsies performed. The overall prevalence of GIM on those endoscopies was 8 % and the rate of HP was 3 %. Of individuals without GIM detected on the initial upper endoscopy, 4 % had GIM identified on their second, and 2 % had GIM identified on a third or greater upper endoscopy after having two prior upper endoscopies without GIM identified. There was no additional HP identified on subsequent endoscopies. Plasma HP IgG positivity amongst 257 LS carriers was 14 %. CONCLUSIONS: Amongst a LS cohort undergoing serial upper endoscopies, repeat gastric antrum/body biopsies yielded new cases of GIM, providing support for consideration of non-targeted gastric biopsies on all upper endoscopies performed in LS. Additionally, although endoscopic HP detection rates are low, HP exposure in LS is more common.