Stool-based testing for post-polypectomy colorectal cancer surveillance safely reduces colonoscopies: The MOCCAS study

• Published in: Gastroenterology (New York, N.Y. 1943)
• Main Authors: Carvalho, Beatriz, de Klaver, Willemijn, van Wifferen, Francine, van Lanschot, Meta C J, van Wetering, Alouisa J P, van der Zander, Quirine E W, Lemmens, Margriet, Bolijn, Anne S, Tijssen, Marianne, Diemen, Pien Delis-van, Buekers, Nikkie, Daenen, Kathleen, van der Meer, Jaleesa, van Mulligen, Pauline G, Hijmans, Brenda S, de Ridder, Sander, Meiqari, Lana, Bierkens, Mariska, van der Hulst, René W M, Kuyvenhoven, Johan P H, van Berkel, Annemarie M, Depla, Annekatrien C T M, van Leerdam, Monique E, Jansen, Jeroen M, Wientjes, Caroline A, Straathof, Jan-Willem A, Keulen, Eric T P, Ramsoekh, Dewkoemar, Moons, Leon M G, Zacherl, Michael, Masclee, Ad A M, de Wit, Meike, Greuter, Marjolein J E, van Engeland, Manon, Dekker, Evelien, Coupé, Veerle M H, Meijer, Gerrit A
• Format: Journal Article
• Language: English
• Published: United States 28.08.2024
• Subjects: Health Technology Assessment; Early detection
• ISSN: 1528-0012

Colonoscopy-based surveillance to prevent colorectal cancer (CRC) causes substantial burden for patients and healthcare. Stool tests may help to reduce surveillance colonoscopies, by limiting colonoscopies to individuals at increased risk of AN. This cross-sectional observational study included individuals aged 50-75 with surveillance indication. Before bowel preparation, participants collected samples for a multitarget stool DNA (mt-sDNA) test and two fecal immunochemical tests (FITs). Test accuracies were calculated for all surveillance indications. Only for the post-polypectomy indication, most common and associated with a relatively low CRC risk, long-term impact of stool-based surveillance was evaluated with the ASCCA model. Stool-based strategies were simulated to tune each tests' positivity threshold to obtain strategies at least as effective as colonoscopy surveillance. 3453 individuals had results for all stool tests and colonoscopy. 2226 had previous polypectomy, 1003 previous CRC and 224 familial risk. Areas under the receiver operating characteristic curve for AN were 0.72 (95% CI; 0.69-0.75) for the mt-sDNA test, 0.61 (95% CI; 0.58-0.64) for the FIT OC-Sensor and 0.59 (95% CI; 0.56-0.61) for the FIT FOB-Gold. Stool-based post-polypectomy surveillance strategies at least as effective as colonoscopy surveillance, reduced the number of colonoscopies by 15-41% and required 5.6-9.5 stool tests over the lifetime of a person. Mt-sDNA-based surveillance was more costly than colonoscopy surveillance, whereas FIT-based surveillance saved costs. This study shows that stool-based post-polypectomy surveillance strategies can be safe and cost-effective, with potential to reduce the number of colonoscopies by up to 41%.