175 Evaluation of a Diagnostic Pathway Incorporating Capsule Sponge for Patients with Reflux Symptoms

Abstract Aim To evaluate a clinical pathway incorporating capsule sponge (CS), a non-endoscopic pan-oesophageal cell collection device used to detect Barrett’s oeosphagus and its impact on endoscopy. Method Patients with dyspepsia were triaged to gastroscopy, with reflux to the CS clinic. Patients were referred for gastroscopy if they were unable to tolerate CS, had troublesome symptoms at follow up, positive CS findings or insufficient samples. Results Between August 2021 and December 2024, 451 referrals were triaged to CS, 372 to gastroscopy. In the CS group, 362 samples were sufficient, 31 OGDs were performed for intestinal metaplasia, 1 with atypia. 331 were negative for Barrett’s; at follow up, 50 with troublesome symptoms were referred for OGD. 76 additional cases were referred for OGD; 54 samples were insufficient, 22 patients could not tolerate CS. In the CS group, 287 (64%) were managed without gastroscopy. In the CS group - 59% had oesophagitis +/- hiatal hernia, 5% Barrett’s, 22 % had normal findings compared to 48%, 3% and 29% respectively in the dyspepsia group. 5 oesophageal cancers were identified; 4 in the dyspepsia group, 1 in the CS group, which was predicted by the CS result. Conclusions Using CS to exclude complications of reflux allowed 64% of patients to be managed without gastroscopy, reducing pressure on waiting lists. CS can be used to identify high risk cases and improve delays in diagnosis. The large number of normal or minor endoscopic findings suggests a greater reduction in OGD referrals could be made.