OGC P31 On the role of Cytosponge for Barrett’s surveillance: assessment of viability and safety of this new technology

Abstract

Abstract Background Barrett’s Oesophagus is a pre-malignant change where the normal stratified squamous epithelium is replaced by intestinal columnar epithelium. Current guidance produced by the British Society of Gastroenterologists describes 'gold-standard' surveillance as regular upper GI endoscopy with quadrantic biopsies for every 2cm length of Barrett’s oesophagus. The Covid pandemic led to significant delays in the Barrett's surveillance; as a result, many patients have fallen outside their maximum recommended surveillance interval. Cytosponge is a novel cytology sampling device which has a potential role in Barrett's surveillance though its use for this condition remains controversial. Methods All patients who were due for Barrett's surveillance in 2022 were identified and screened for suitability for Cytosponge, instead of endoscopy. Patients who were ineligible, or who declined Cytosponge, were sent for endoscopy. The remaining patients underwent a Cytosponge procedure as their primary Barrett's surveillance modality. Early clinical outcomes, patient satisfaction and cytology results were recorded. All patients have been followed up to determine if they have subsequently required endoscopy or had an early diagnosis of oesphago-gastric cancer. Results 193 patients (77%) were suitable for the Cytosponge test. 175 (90%) did not require endoscopy after Cytosponge. 18 patients (10%) had urgent endoscopy after Cytosponge; 9 patients had atypia on cytological analysis, 3 had aberrant p53 and 4 had dysplasia. Three patients had inadequate cytology. 2 of the patients with dysplasia had high-grade dysplasia confirmed on endoscopy; these were successfully treated with radiofrequency ablation. Median follow-up was 14 months (range, 10-22). No patients have been diagnosed with oesophago-gastric cancer so far; 8 patients (4%) were referred later for anaemia or weight loss. None of these patients had oesophago-gastric cancer. Conclusions These data suggest that Cytosponge can be a valuable first-line tool in surveillance of Barrett’s Oesophagus. Cytology results identified specific patients who required urgent endoscopy. No patients have had an early diagnosis of dysplasia or malignancy after a Cytosponge that was normal or showed intestinal metaplasia alone. Our findings suggest that Cytosponge should be integrated as an adjunct in Barrett’s surveillance, with clear benefits in safer and accurate monitoring of the condition without the risks of endoscopy.