Study: Stool tests show promise in reducing colonoscopies for post-polypectomy colorectal cancer surveillance

Editor's Note

Stool-based testing strategies could significantly reduce the number of colonoscopies required for post-polypectomy colorectal cancer (CRC) surveillance while maintaining equivalent long-term outcomes in cancer incidence and mortality, according to research published August 30 in Gastroenterology.

Conducted in the Netherlands, the cross-sectional observational study compared three stool tests—multitarget stool DNA (mt-sDNA) and two fecal immunochemical tests (FIT)—with colonoscopy to evaluate their accuracy in detecting advanced neoplasia. Results from 3,453 participants showed that the mt-sDNA test had higher accuracy. However, the FIT-based strategies proved to be more cost-effective.

Stool-based surveillance could reduce colonoscopy frequency by 15-41%, depending on the test and interval used, with the most significant reduction achieved through annual FIT-based testing, researchers write. The FIT FOB-Gold at a threshold of ≥32 µg/g was identified as the most effective, reducing colonoscopies by 41%.

Researchers emphasize the burden associated with colonoscopy-based surveillance, particularly given the increased numbers of individuals referred for surveillance following CRC screenings.   

Limitations of the study include its observational nature and the need for further prospective validation before clinical implementation. Still, researchers write that their findings could inform future evaluations of FIT-based strategies as a feasible and cost-effective alternative to colonoscopy for post-polypectomy surveillance, potentially reducing patient burden and healthcare costs.