Targeted screening of at-risk patients with chronic heartburn using a non-endoscopic capsule sponge device can enhance the detection of Barrett’s oesophagus

Introduction Chronic heartburn from acid reflux can lead to Barrett’s oesophagus (BE), which in turn may predispose to oesophageal adenocarcinoma (OAC). The 5-year survival for OAC remains poor, but earlier identification improves outcomes. Swallowable non-endoscopic capsule sponge tests (eg, EndoSign) have been investigated to aid early diagnosis as a screening tool. Methods In February 2024, Heartburn Cancer UK (HCUK) charity in collaboration with Cleveland Clinic London launched a campaign to raise awareness on chronic heartburn and OAC. Members of the public with chronic heartburn were invited to self-refer using an online screening tool targeting high-risk individuals. Those eligible were offered EndoSign at a mobile testing unit. Samples were analysed for cellular atypia, trefoil factor 3 and p53. Individuals with cellular abnormalities were invited to undergo gastroscopy for the primary outcome of BE detection. Results In total, 78 individuals (mean age 57.1 (SD 9.4), 85.9% male) were invited to undergo EndoSign with 65 confirming. Sixty individuals (92.3%) could swallow the capsule with no detachments or adverse events. Among 54 conclusive results, 12 (22.2%) had positive findings: intestinal metaplasia (n=10), cellular atypia (n=1) and ulceration (n=1). Eleven individuals chose to undergo gastroscopy. BE was detected in eight (14.8%) with a median Prague classification of C2M3. Three had an irregular squamocolumnar junction. There was one BE-associated low-grade dysplasia (1.9%). The positive predictive value for detection of BE was 72.7% (95% CI 43.5 to 91.7%). Conclusion Through a targeted charity campaign, capsule sponge testing in an at-risk population can enhance the detection of BE and associated dysplasia.