Feasibility of Using Point-of-Care Isoenzyme Type M2 Pyruvate Kinase Quick Stool Test to Facilitate Earlier Diagnosis of Gastric Cancer in Rwanda

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Abstract
PURPOSE: Gastric cancer (GC) is the fourth most common cancer in Rwanda, but access to endoscopy remains limited. Delays in diagnosis contribute to the poor prognosis. The aim of this study was to assess the feasibility of the point-of-care (POC) isoenzyme type M2 pyruvate kinase stool test to facilitate earlier triage of patients with suspected GC who require esophagogastroduodenoscopy. METHODS: We enrolled patients with gastrointestinal symptoms scheduled for endoscopy during the Annual Rwanda Endoscopy Week, sponsored by the Rwanda Society for Endoscopy from 2022 to 2024. Participants provided informed consent and a stool sample before endoscopy. Using the M2 pyruvate kinase test, we collected data on test results, baseline demographics, endoscopic findings, and gastric biopsy results. RESULTS: A total of 82 patients consented before the study was discontinued because of the Marburg virus epidemic. Forty-six participants had incomplete data because of the absence of a gastric biopsy or a stool sample, and three did not meet the eligibility criteria. Thirty-six participants (43.9%) had both M2 pyruvate kinase and esophagogastroduodenoscopy results. Pathology was available in 19 of 82 patients (23%). CONCLUSION: Screening with a POC stool test is feasible and acceptable among Rwandan patients with gastrointestinal symptoms. However, there are many limitations, including low biopsy rates as a result of the cost of pathology services, expired test kits, and early closures. POC testing may be a feasible, opportunistic strategy to implement cancer control programs in low-income countries, but further research is needed for better quantification of sensitivity, specificity, and impact on the prevention of adverse outcomes.

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