GuidelineJoint Asian Pacific Association of GastroenterologyOPEN ACCESS(APAGE)-Asian Pacific Society of Digestive Endoscopy(APSDE)clinical practice guidelines on the use ofnon-invasive biomarkers for diagnosis ofcolorectal neoplasiaFrancis K L Chan,Martin CS Wong ,2.3 AndrewT Chan4.5.6James E East7 Han-Mo Chiu Govind K Makharia1 David Weller,11Choon Jin Ooi,2 Julajak Limsrivilai Yutaka Saito,4Dao VHang,15Jon D Emery,16 Dadang Makmun,17 Kaichun Wu,18 Raja Affendi Raja Ali,9Siew C NgFor numbered affiliations seeABSTRACTCRCcases.Accordingto the projection from GLOB-end of article.Screening for colorectal cancer (CRC)is effective inOCAN 2020,the total number of new CRC casesreducing CRC related mortality.Current screeningwill rise from 1.03 million in 2020 to 1.76millionCorrespondence tomethods include endoscopy based and biomarker basedin 2040,with a substantial increase observed inProfessor Siew C Ng:siewchienng@cuhk.edu.hkapproaches.This guideline is a joint official statementAsian countries.In addition,the global level ofProfessor Raja Affendi Raja Ali:of the Asian Pacific Association of GastroenterologyCRC screening has been growing,using a range ofdraffendi@ppukm.ukm.edu.my(APAGE)and the Asian Pacific Society of Digestivetechnologies.A recent evaluation found that theDr Kaichun Wu:Endoscopy(APSDE),developed in response to thekaicwu@fmmu.edu.cnglobal expenditure incurred from CRC screeningincreasing use of,and accumulating supportive evidencewas estimated to be US$662.8 million in 2020 withFKLC and MCSW contributedfor the role of,non-invasive biomarkers for the diagnosisa projected rise to USS728.6 million in 2026.Withequally.of CRC and its precursor lesions.A systematic reviewrising disease incidence and cancer awareness,theof 678 publications and a two stage Delphi consensusFKLC and MCSW are joint firstdemand for CRC screening is predicted to furtherauthors.process involving 16 clinicians in various disciplinesescalate,and the Asia-Pacific region is expected towas undertaken to develop 32 evidence based andhave the largest market growth for CRC screening.Received 3 January 2023expert opinion based recommendations for the useCurrently,common screening tests for CRCAccepted 7 March 2023of faecal immunochemical tests,faecal based tumourinclude faecal occult blood tests (FOBTs),faecalbiomarkers or microbial biomarkers,and blood basedimmunochemical tests (FITs),flexible sigmoidos-tumour biomarkers for the detection of CRC andadenoma.Comprehensive up-to-date quidance iscopy and colonoscopy.However,novel non-invasive tests,including tumour DNA and microbialprovided on indications,patient selection and strengthsmarkers,have recently become one of the majorand limitations of each screening tool.Future researchto inform clinical applications are discussed alongsidedriving forces for a growth in expenditure on CRCscreening.s The market size of these non-invasiveobjective measurement of research priorities.This jointtests is likely to be more than USS1000
