P29 Utilising cytosponge to reduce the post-covid gastroscopy backlog

Published Date: 01st July 2024

Publication Authors: Norris. G, Brunskill. L, Dickinson. K, McClements. D

Introduction The post-Covid-19 era brought about significant challenges in relation to the waiting times for endoscopy procedures. Resources were re-directed to the front-line resulting in a temporary cessation of non-urgent endoscopy services. Delays to endoscopy provision can have a devastating effect on the prognosis of oesophagogastric cancers. Innovative test such as Cytosponge may be utilised.

Methods The Cytosponge device is an NHS England initiative, aimed at providing an alternative, first-line investigative method for patients with gastroesophageal reflux disease (GORD). The procedure involves the swallowing of a small, tethered capsule which dissolves within the stomach to produce a mildly abrasive sponge that is designed to collect cellular material from the proximal stomach and oesophageal body, during retrieval. Cytological assessment is performed through microscopy and immunohistochemical investigation, to identify Trefoil Factor 3 (TFF3), a molecular biomarker for intestinal metaplasia, and P53, a biomarker used to identify cellular atypia and dysplasia.

Over a period of 14 months, the Cytosponge device was used to assess 115 patients referred routinely by their GP with symptoms of GORD, and 145 patients on the Barrett’s surveillance programme.

Results In the uncomplicated reflux cohort, 76.5% of patients received a negative test result and were able to be discharged back to their GP for treatment of GORD, without the need for endoscopic assessment. A new diagnosis of Barrett’s oesophagus was indicated and subsequently confirmed endoscopically in 5.3% of patients within this cohort.

Within the Barrett’s surveillance cohort, 145 Cytosponge procedures were performed, and of these, 75.2% were relisted for routine follow up in 3–5 years, as per BSG guidelines, 14.5% required endoscopic assessment and 8.3% were discharged from the surveillance programme after case review. Significant pathology (dysplasia or cancer) was confirmed in 1.4% of cases.

Conclusion A key advantage of the Cytosponge procedure, lies within its ability to be performed outside of the endoscopy unit, and by non-specialised clinical staff. This decentralised approach expedites the diagnostic pathway, whilst opening up endoscopy capacity, mitigating the strain on services. Within this small study, an additional 213 gastroscopy slots were saved in lieu of Cytosponge performance, avoiding endoscopic assessment in 81.9% of the total study cohort. By diverting low-risk referrals, complex, urgent cases were able to be prioritised, optimising the utilisation of senior, specialist clinical personnel, whilst enhancing the efficiency of the reflux pathway.

Norris, G.; Brunskill, L.; Dickinson, K.; McClements, D. (2024). P29 Utilising cytosponge to reduce the post-covid gastroscopy backlog. Gut. 73(Suppl. 1), p.A66. [Online]. Available at: https://gut.bmj.com/content/73/Suppl_1/A66.1 [Accessed 22 October 2024].

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