OGC SO35 - Capsule-sponge assessment of long segment Barrett's Oesophagus

Abstract Background Capsule-sponge technology is increasingly utilised in assessment of reflux, though NICE still recommends its usage for surveillance of Barrett's Oesophagus to be conducted carefully. Our hospital has utilised capsule-sponge technology for two years in the surveillance of Barrett's Oesophagus, whilst adhering to strict guidance and recommendations from national bodies. This study aimed to assess the performance and effectiveness of capsule-sponge assessment of long segment Barrett's Oesophagus. Method From September 2022 to June 2024, 379 patients received capsule-sponge assessment of their Barrett's Oesophagus using the CytospongeTM device. All patients were entered onto a prospectively maintained database and those with a previously identified long segment with no p53 positivity or atypia on initial sponge analysis were brought forward for endoscopic assessment at 12 months, rather than the current standard of 18 to 24 months. Endoscopy results were recorded and patients assessed for development of inter-test malignancy. Results 14 patients who had a Cytosponge (4%) were identified with a previously measured long-segment of Barrett's Oesophagus. The range of Prague Classification was C (6-12cm) M (6-13cm) and none of the patients had previously had dysplasia. All patients were offered surveillance endoscopy at 12 months. One patient refused endoscopy due to discomfort, though she did agree to continued capsule-sponge testing. Of the remaining 12 patients, all had successful endoscopy and Barrett's mapping. None had developed inter-test malignancy and all had persisting long segment Barrett's oesophagus. There were no other concerning findings at endoscopy. Conclusion Capsule sponge assessment of long segment Barrett's Oesophagus is safe and well tolerated. Patient feedback universally favoured capsule sponge over endoscopic assessment, particularly because of the increased length of time required for mapping of long segment disease. Poor tolerance of endoscopy led to refusal to have endoscopic surveillance in at least one patient in this series. By increasing frequency of capsule sponge assessment, even patients with long segment Barrett's Oesophagus may be suitable for regular surveillance without endoscopy.