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Optimizing Colonoscopy Capacity to Maximize Colorectal Cancer Outcomes.

A Mark Fendrick¹, Jacob E Kurlander^1,2,3, Vahab Vahdat⁴

¹Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan.

Gastro Hep Advances

|April 24, 2026

Summary

This summary is machine-generated.

Shifting colorectal cancer (CRC) screening to more stool-based tests and reallocating colonoscopies for follow-up can increase CRC case detection and prevention. This strategy maximizes colonoscopy efficiency, boosts revenue, and reduces overall healthcare costs.

Keywords:

Backlog Endoscopy Stool Test Substitute

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Published on: March 24, 2023

Area of Science:

Gastroenterology
Public Health
Health Economics

Background:

Current guidelines recommend endoscopic and stool-based testing for colorectal cancer (CRC) screening.
Limited colonoscopy capacity poses a challenge for screening all eligible individuals.
Optimizing colonoscopy utilization is crucial for effective CRC screening and follow-up.

Purpose of the Study:

To identify optimal screening scenarios that maximize colonoscopy benefits.
To evaluate strategies for screening all eligible individuals within existing colonoscopy capacity.
To assess the impact of shifting screening modalities on CRC detection, prevention, and costs.

Main Methods:

Modeled annual screening modality distribution in the United States.
Compared clinical outcomes and costs of current versus alternative screening scenarios.
Assessed scenarios substituting initial colonoscopy screening with stool-based tests to maintain full colonoscopy capacity.

Main Results:

An optimal scenario requires a 2.4-fold increase in stool-based tests and a decrease in screening colonoscopies.
Follow-up colonoscopies would increase to 22% of capacity, detecting 84% more CRC cases and preventing 49% more cases.
Total CRC costs would decrease by $7.2 billion, while colonoscopy revenue would increase by $0.5 billion.

Conclusions:

Reallocating colonoscopies for follow-up and increasing stool-based testing enhances health benefits.
This strategy maximizes colonoscopy efficiency and revenue.
The approach reduces overall healthcare expenditures for colorectal cancer.