OGC O04 - The role of capsule-sponge technology in Barrett's surveillance: A two-year experience

Abstract Background Barrett's surveillance requires regular endoscopic and histological assessment of the oesophagus to reduce the risk of progression to oesophageal cancer. Capsule-sponge technology has been used in the assessment of reflux for some years, and is increasingly used as an adjunct or replacement for endoscopic surveillance of Barrett's. Current NICE guidance does not advocate complete replacement of surveillance with capsule-sponge assessment but notes the potential benefits of the technology and highlights the requirement for more evidence and research. This study aimed to describe two-year experience with capsule-sponge technology in the surveillance of Barrett's Oesophagus. Method All patients who were due for Barrett's surveillance from September 2022 to June 2024 were screened to see if they were appropriate for capsule-sponge assessment. Appropriate patients were approached and offered capsule-sponge assessment. Patients who were not appropriate, or declined, were offered standard endoscopic surveillance. Capsule sponge assessment was performed using the CytospongeTM and sponges sent to Cyted for cytological analysis. All patients were entered onto a prospectively maintained database and monitored for progression of symptoms or development of gastro-oesophageal cancer. Cost implications, clinical outcomes and impact on endoscopy resource utilisation were measured. Results 379 patients had Cytosponge assessment for Barrett's oesophagus. 34 (9%) required endoscopy for either an abnormal cytology or an inadequate sample. Cytosponge assessment picked up many pathologies including high-grade dysplasia, oesophageal carcinoma and ulceration or atypia. All patients who had a Cytosponge have been booked for endoscopy for their next Barrett's assessment (in keeping with current guidelines); none have presented with inter-test malignancy. Over the same time period, three patients have presented with oesophageal cancer who have only had endoscopic assessment. Utilisation of capsule-sponge technology has saved almost 350 endoscopies (700 points) over 21 months, or over 70 endoscopy lists. Conclusion Utilisation of capsule-sponge assessment for Barrett's oesophagus is safe and effective and can have a rapid and sustainable effect on reducing demand on endoscopy lists. The procedure is better tolerated than endoscopy, reproducible and may be a more accurate method of Barrett's surveillance than endoscopy alone.