Key Messages

1. Capsule sponge technologies are potentially an alternative or precursor to endoscopy for diagnosing Barrett’s oesophagus or early-stage oesophageal cancer.
2. Using capsule sponge testing as a triage tool has been shown to facilitate access to endoscopy for patients who are at the greatest risk of a clinically significant diagnosis and reduce endoscopy waiting lists.
3. Capsule sponge technologies are likely to misdiagnose approximately 28% of patients tested. Endoscopy has been reported to miss between 21% and 23.5% of early oesophageal cancers in patients with Barrett’s oesophagus.
4. The majority of patients asked found capsule sponge testing an acceptable alternative to endoscopy.
5. A budget impact model for the NHS found that the use of capsule sponge testing for patients with chronic reflux symptoms referred for an endoscopy led to resource savings.
6. Please note that all the evidence on capsule sponge technologies relates to the Cytosponge™ device which is no longer used in NHSScotland.

What were we asked to look at?

The Scottish Health Technologies Group (SHTG) was asked to evaluate the use of capsule sponge devices to detect Barrett’s oesophagus and early-stage oesophageal cancer. We considered clinical effectiveness, cost effectiveness, safety, and the patient experience.

Why is this important?

The majority of people diagnosed with oesophageal cancer in Scotland present with advanced disease. Early detection of oesophageal cancer is associated with improved survival. Patients with early-stage oesophageal cancer have a 5-year survival rate of approximately 95% compared with 5–40% in patients with advanced disease at diagnosis.

Chronic gastro-oesophageal reflux (GORD) and Barrett’s oesophagus are known risk factors for developing oesophageal cancer. People with chronic reflux often undergo endoscopies to detect Barrett’s oesophagus. People with Barrett’s oesophagus undergo routine surveillance endoscopies to detect early signs of cancer. Most people with chronic reflux or Barrett’s oesophagus do not progress to having cancer. Providing endoscopies for these two patient groups contributes to a high demand on endoscopy services.

During the COVID-19 pandemic many endoscopies were cancelled, resulting in long patient waiting lists. The Scottish Government recognised the potential for capsule sponge technologies to improve patient access to cancer diagnosis and reduce endoscopy waiting times.

Referred by 

The Accelerated National Innovation Adoption (ANIA) collaborative