STOOL-BASED TESTING TO REDUCE THE NUMBER OF UNNECESSARY SURVEILLANCE COLONOSCOPIES: THE MOCCAS STUDY

Aims The yield of colonoscopy surveillance after colorectal cancer screening is limited. To lower patient burden and healthcare costs, there is a need to reduce colonoscopies in which no advanced neoplasia is detected. The MOlecular stool testing for Colorectal CAncer Surveillance (MOCCAS) study evaluated whether stool-based testing could safely reduce the number of surveillance colonoscopies.

Methods This cross-sectional study included patients under colonoscopy surveillance, who performed the multi-target stool DNA test (mt-sDNA, Cologuard) and two fecal immunochemical tests (FITs, OC-Sensor and FOB-Gold) before colonoscopy. Test characteristics were determined for all stool tests. With the validated Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model, we simulated a colonoscopy surveillance (European post-polypectomy surveillance guideline) strategy and stool-based surveillance strategies that varied in stool-based test and test interval. We chose test cut-offs such that predicted effectiveness (colorectal cancer mortality) of stool-based surveillance equaled effectiveness of colonoscopy surveillance. Outcomes of each strategy included number of colonoscopies and costs.

Results 3453 Patients had a valid result for all stool tests and a complete colonoscopy. Colonoscopy surveillance was predicted to result in 1669 lifetime colonoscopies per 1000 individuals under surveillance. At equal effectiveness, fewer colonoscopies were predicted for all stool-based strategies (16-41% reduction). Annual testing with FOB-Gold led to the largest reduction in colonoscopies (41%, cut-off≥32 µg/g). Mt-sDNA surveillance was more costly than colonoscopy surveillance, while FIT-based surveillance saved costs.

Conclusions Stool-based surveillance can be as effective as post-polypectomy colonoscopy surveillance, and reduces the number of colonoscopies by up to 41% without increasing healthcare costs.

Publication History

Article published online:
14 April 2022