In an interview with《The Icons》, it was revealed that a novel diagnostic test developed by researchers from the University of Cambridge and trialled by the NHS has significantly reduced the necessity for invasive endoscopy in thousands of patients at low risk. This innovation has been instrumental in alleviating the demand for endoscopies, thus prioritising capacity for patients at higher risk and those urgently referred for oesophageal cancer tests.
The NHS pilot, which assessed over 8,500 patients using the ‘capsule sponge test’, demonstrated that nearly eight out of ten patients who underwent the test were discharged without the need for further examinations. This has notably freed up endoscopy resources for patients at a higher risk and those urgently needing tests for oesophageal cancer.
The procedure entails patients swallowing a diminutive capsule-like device containing a tiny sponge designed to collect cell samples for analysis. Following collection, the sponge is retrieved through a string thread attached to it. The innovative test was developed by Professor Rebecca Fitzgerald, Director of the Early Cancer Institute at the University of Cambridge.
Professor Fitzgerald expressed her enthusiasm about the NHS England’s real-world pilot’s positive outcomes for the capsule-sponge test. She remarked, “It is tremendously exciting to witness the favourable results of the NHS England real-world pilot for our capsule-sponge test. This marks a significant advancement in making this straightforward test more widely available beyond clinical trials. Prompt diagnosis is crucial for enhancing patient outcomes.”
Barrett’s oesophagus, a condition affecting the oesophagus that may lead to oesophageal cancer in some patients, is typically diagnosed or excluded through an endoscopy following a referral from a GP to a gastroenterologist or another specialist capable of performing the procedure.
The sponge-on-a-string test trialled by the NHS offers a quick and non-sedative alternative during a brief appointment.
Amanda Pritchard, Chief Executive of the NHS, stated, “Thousands have now benefited from this incredibly efficient test within the NHS – whilst the sponge on a string is compact in size, it can significantly impact patients – allowing them to conveniently incorporate the test into their day. It often obviates the need for an endoscopy whilst also aiding in reducing waiting lists by freeing up staff and resources.”
In a survey conducted among over 250 patients who had undergone the capsule sponge test, many reported they would recommend the test to friends or family, with 94% experiencing only mild or no discomfort whatsoever.
The NHS initiated the test pilot during the pandemic amid heightened service pressures and a growing backlog for endoscopies.
Gastro-oesophageal reflux, or acid reflux, affects approximately one to two in every ten individuals to some extent, with some of these individuals potentially having or developing Barrett’s oesophagus, a precursor to oesophageal cancer.
There are around 9,300 new cases of oesophageal cancer in the UK annually. Detecting Barrett’s oesophagus at an earlier stage before it becomes cancerous is key to saving lives.
The NHS pilot was launched across 30 hospital sites in 17 areas in England, including Manchester, Plymouth, London, Kent, and Cumbria. The evaluation of the pilot indicated that the capsule sponge is highly cost-effective compared to using only endoscopy for diagnosis, saving approximately £400 per patient.
Patients with positive results from the capsule sponge test referred for an endoscopy had a 27.2% prevalence of Barrett’s oesophagus, compared to none among patients with negative results who completed an endoscopy.
One of the first pilot sites, at East and North Hertfordshire NHS Trust, has now conducted around 1,400 capsule sponge tests – offered to patients with reflux symptoms through a new consultant-led, nurse-run early diagnosis service, as well as to patients on an existing Barrett’s surveillance programme.
In the first 1,000 patients, the capsule test identified Barrett’s in 6% of patients with reflux symptoms and discovered two new cancers and three cases of dysplasia, potentially hastening the diagnosis time. Furthermore, 72% of patients with reflux symptoms were discharged back to their GP without the need for an endoscopy.
As of January, 368 patients have had a positive test result, approximately half of whom have confirmed Barrett’s oesophagus.
Dr Danielle Morris, a consultant gastroenterologist at East and North Hertfordshire NHS Trust, commented, “Employing the capsule sponge test as a diagnostic triage tool has provided immense benefits for patients, avoiding the necessity for an unnecessary gastroscopy in almost seven out of ten patients, and assisting in reducing endoscopy waiting lists. This enables us to prioritise those who truly require an endoscopy to have it conducted promptly.
“The test is performed by a single trained practitioner in an outpatient setting, making it significantly resource-efficient compared to a gastroscopy. Our patients are very supportive of the service – with nearly nine out of ten patients favouring the capsule sponge over a gastroscopy.”
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