Screening for Stomach Diseases and Colorectal Neoplasms With the Fecal Testing

NCT ID: NCT01741363

Last Updated: 2024-11-21

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

View full results

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

99314 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-01

Study Completion Date

2020-12-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

1. The abundant results from this trial will be helpful for assessing the feasibility of increasing stool sampling and shortening screening interval in population setting for lower and upper gastrointestinal tract lesions, their long-term effects, and the respective cost-effectiveness.
2. The study will evaluate the value of population-based screen and treatment for H. pylori infection when the HPSA is combined with the FIT.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Growing body of evidences have shown that fecal immunochemical test (FIT) outperform guaiac fecal occult blood test (gFOBT) in terms of sensitivity, neoplasm detection rate and public participation. Though direct outcome evidence is still lacking for FIT, it is anticipated to have higher colorectal cancer (CRC) mortality and incidence reduction compared with gFOBT. In Taiwan, nation-wide CRC screening program has been launched since the year of 2004 ,which provides biennial FIT screening for adults aged 50 to 69 years. Currently available data from the Bureau of Health Promotion has shown a significant stage-shift effect, an early indicator of screening effectiveness, by this screening program.

Nevertheless, the aforementioned advantages of FIT, missed neoplasms and interval cancer still exists under the current one-day stool sampling method with biennial screening interval, which might affect the effectiveness of overall screening program. Increase the number of stool samples or shortening of screening interval may be helpful for early detection of clinically significant neoplasms but it remains unclear whether such an approach may lower the screenee compliance or public participation. Moreover, its impact on the demand of confirmatory colonoscopy and cost-effectiveness of the whole screening program is still largely unknown and need to be further investigated.

In this study, we firstly aim to randomly allocate screening attendee to one of the following four arms: one-day sampling with annual screening, one-day sampling with biennial screening, two-day sampling with annual screening, and two-day sampling with biennial screening. Participation rate, positive rates of FIT, detection rate for neoplasms, positive predictive value, and long-term outcome including cancer incidence and mortality will be calculated and compared among four groups.

Secondly, in the Taiwanese population, which is a typical presentation of Asian populations, although the incidence of colorectal cancer is rapidly increasing, Helicobacter pylori-related upper gastrointestinal pathologies remain highly prevalent, which may imply that mass screening solely based on FIT could be insufficient as significant upper GI pathologies can be missed. Since the FIT does not predict upper GI pathologies, the adjunct of an「Helicobacter pylori stool-antigen test (HpSA) 」 may be a potential candidate to realize a pan-detecting assay based on stool samples in a population in which both lower and upper GI lesions are equally prevalent. Therefore, in the present study, we will also evaluate the value of simultaneous FIT and HpSA test in the community-based mass screening. We invited subjects in a randomized study to receive the FIT or the FIT plus HPSA. Those who are tested positive for HPSA will receive upper endoscopic examination and anti-H. pylori treatment. For the short-term indicators, we will evaluate the participation rate and diagnostic yield when the HPSA is added. For the long-term indicators, we will compare the incidence and mortality of gastric cancer as well as complicated peptic ulcers.

To summary, this study includes two randomized trials:

1. To make a comparison between one-day sampling with annual screening, one-day sampling with biennial screening, two-day sampling with annual screening, and two-day sampling with biennial screening using FIT;
2. To make a comparison between FIT plus HpSA and FIT alone for screening.

Finally, the cost-effectiveness analysis will be also conducted using previously established Markov model of CRC natural history and stomach diseases (such as dyspepsia, peptic ulcer disease, and gastric cancer) using the results ascertained from this trial. The primary outcomes were gastric cancer incidence and mortality rates as well as colorectal cancer incidence and mortality rates.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Colorectal Cancer Stomach Disease

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

one-day sampling with one-year interval

FIT one-day sampling with one-year interval

Group Type EXPERIMENTAL

FIT(Eiken OC-Sensor) One-year interval

Intervention Type OTHER

Screening with one-year interval

FIT(Eiken OC-Sensor) One-day sampling

Intervention Type OTHER

One-day sampling

one-day sampling with two-year interval

FIT one-day sampling with two-year interval

Group Type ACTIVE_COMPARATOR

FIT(Eiken OC-Sensor) One-day sampling

Intervention Type OTHER

One-day sampling

FIT(Eiken OC-Sensor) Two-year interval

Intervention Type OTHER

Screening with two-year interval

two-day sampling with one-year interval

FIT two-day sampling with one-year interval

Group Type EXPERIMENTAL

FIT(Eiken OC-Sensor) Two-day sampling

Intervention Type OTHER

Collect two stool samples in two separate days

FIT(Eiken OC-Sensor) One-year interval

Intervention Type OTHER

Screening with one-year interval

two-day sampling with two-year interval

FIT two-day sampling with two-year interval

Group Type EXPERIMENTAL

FIT(Eiken OC-Sensor) Two-day sampling

Intervention Type OTHER

Collect two stool samples in two separate days

FIT(Eiken OC-Sensor) Two-year interval

Intervention Type OTHER

Screening with two-year interval

Hp stool antigen (HpSA)+FIT

HpSA for detection of upper gastrointestinal tract diseases and upper endoscopy for H. pylori carriers; HPSA combined with FIT

Group Type EXPERIMENTAL

FIT(Eiken OC-Sensor) One-day sampling

Intervention Type OTHER

One-day sampling

FIT(Eiken OC-Sensor) Two-year interval

Intervention Type OTHER

Screening with two-year interval

HpSA (Firstep Helicobacter pylori Antigen Rapid Test)

Intervention Type OTHER

HpSA for detection of upper gastrointestinal diseases; screen and treat for H. pylori infection. Upper endoscopy for H. pylori carriers. HPSA+FIT compared with FIT alone.

FIT only

HpSA + FIT compared with FIT alone

Group Type ACTIVE_COMPARATOR

FIT(Eiken OC-Sensor) One-day sampling

Intervention Type OTHER

One-day sampling

FIT(Eiken OC-Sensor) Two-year interval

Intervention Type OTHER

Screening with two-year interval

FIT only

Intervention Type OTHER

HPSA+FIT compared with FIT alone.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

FIT(Eiken OC-Sensor) Two-day sampling

Collect two stool samples in two separate days

Intervention Type OTHER

FIT(Eiken OC-Sensor) One-year interval

Screening with one-year interval

Intervention Type OTHER

FIT(Eiken OC-Sensor) One-day sampling

One-day sampling

Intervention Type OTHER

FIT(Eiken OC-Sensor) Two-year interval

Screening with two-year interval

Intervention Type OTHER

HpSA (Firstep Helicobacter pylori Antigen Rapid Test)

HpSA for detection of upper gastrointestinal diseases; screen and treat for H. pylori infection. Upper endoscopy for H. pylori carriers. HPSA+FIT compared with FIT alone.

Intervention Type OTHER

FIT only

HPSA+FIT compared with FIT alone.

Intervention Type OTHER

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* 50 to 69 years average-risk subjects for FIT
* 50 to 69 years subjects for HpSA

Exclusion Criteria

* Subjects who are unwilling to participate
* Subjects ineligible for colonoscopy (for the one-day vs two day FIT screening)


* Subjects with a history of total gastrectomy
* Pregnancy
* Subjects with severe illnesses
* Subjects with prior participation in the pilot program
Minimum Eligible Age

50 Years

Maximum Eligible Age

69 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Ministry of Health and Welfare, Taiwan

OTHER_GOV

Sponsor Role collaborator

National Taiwan University Hospital

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Han-Mo Chiu, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Department of Internal Medicine & Health Management Center

Yi-Chia Lee, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

National Taiwan University Hospital

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

National Taiwan University Hospital

Taipei, , Taiwan

Site Status

Countries

Review the countries where the study has at least one active or historical site.

Taiwan

References

Explore related publications, articles, or registry entries linked to this study.

Lee YC, Chiang TH, Chiu HM, Su WW, Chou KC, Chen SL, Yen AM, Fann JC, Chiu SY, Chuang SL, Chen YR, Chen SD, Hu TH, Fang YJ, Wu MS, Chen TH, Yeh YP; Collaborators of Taiwan Community-based Integrated Screening Group. Screening for Helicobacter pylori to Prevent Gastric Cancer: A Pragmatic Randomized Clinical Trial. JAMA. 2024 Nov 19;332(19):1642-1651. doi: 10.1001/jama.2024.14887.

Reference Type DERIVED
PMID: 39348147 (View on PubMed)

Lee YC, Chiang TH, Chiu HM, Wu MS, Yeh YP, Hsiu-Hsi Chen T; Collaborators of the Taiwan Community-Based Integrated Screening Group. Community-Based Gastric Cancer Screening Coupled With a National Colorectal Cancer Screening Program: Baseline Results. Gastroenterology. 2021 May;160(6):2159-2161.e4. doi: 10.1053/j.gastro.2021.01.008. Epub 2021 Jan 11. No abstract available.

Reference Type DERIVED
PMID: 33444571 (View on PubMed)

Provided Documents

Download supplemental materials such as informed consent forms, study protocols, or participant manuals.

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

201205030RIB

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Stool Sample Collection Study
NCT06294873 RECRUITING