Introduction The estimated annual incidence for oesophageal adenocarcinoma in individuals with Barrett’s oesophagus is 0.2–0.5%¹. However, endoscopic screening of individuals with risk factors for Barrett’s oesophagus including chronic heartburn and reflux² are not part of current clinical recommendations. The cytosponge, a non-endoscopic immunocytological screening kit is undergoing a multicentre study and promises to alter our current practice³. The cytosponge is less invasive than gastroscopy and would reduce the burden on endoscopy units if screening is to be introduced. It has also been shown to detect other benign diseases such as helicobacter, oesophagitis and candidiasis⁴ and therefore may be able to replace routine gastroscopy in symptomatic patients. The aim of this study was to examine the percentage of endoscopy referrals to St Marys hospital that could be alternatively investigated with a non-endoscopic sampling method such as the cytosponge to detect Barrett’s oesophagus and/or exclude more serious pathology.

Methods All pending endoscopy requests were audited on a randomly selected day. Of these, gastroscopy referrals from GP practises and outpatient department were analysed. Patients who were suitable for the cytosponge were identified using the following criteria. Inclusion - Age 45 years and above, symptoms of dyspepsia and reflux; Exclusion - Previous diagnosis of Barrett’s oesophagus, previous endoscopy in the last year, portal hypertension, patients on clopidogrel or warfarin, clotting disorders.

Results A total of 161 gastroscopy referral forms were analysed; 73% from outpatients and 27% from GP surgeries. 22% of referrals were for dyspepsia and 8% for reflux. 16% of referrals were suitable for cytosponge as defined by the inclusion and exclusion criteria.

Conclusion One in six referrals from GP surgeries and outpatients could be offered cytosponge instead of endoscopy for detection of Barrett’s oesophagus. Cytosponge would reduce cost, enable rapid bedside testing and provide a non-invasive method for individuals reluctant to have an endoscopic procedure. It could also be extended to detect benign oesophageal pathology and therefore avoid secondary care referrals and waiting list pressures.

Disclosure of Interest None Declared.

References

1. Yousef F et al. The incidence of esophageal cancer and high-grade dysplasia in Barrett’s oesophagus: a systematic review and meta-analysis. Am J Epidemiol. 2008: 168:237–49

2. Guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus. BSG. 2005

3. Kadri SR et al. Acceptability and accuracy of a non-endoscopic screening test for Barrett’s oesophagus in primary care: cohort study. BMJ. 2010: Sep 10: 341:c4372

4. O’Donovan M, Lao-Sirieix P and Fitzgerald RC, Non-endoscopic diagnostic tests for esophageal diseases and H.pylori using the Cytosponge, Gastroenterology. 2012: Vol. 142, Issue 5, Supplement 1, Page S-421