Introduction An endoscopic Barrett’s Oesophagus (BO) surveillance programme uses significant endoscopic resource but will detect early changes of dysplasia; Cytosponge was introduced in Scotland as an emergency response to the COVID-19 pandemic when endoscopy was not available. We describe the impact of Cytosponge for BO surveillance on our endoscopic biopsy pathology pattern.

Methods A prospectively maintained database of all pathology reports coded as BO from 2015 to present was interrogated. The same sample three-month period from each calendar year was selected and worst pathology was recorded. The years 2015 to 2019 inclusive were designated pre-COVID years as a baseline for our service. Cytosponge was introduced after the 2020 study sample.

Results In the study period, 1268 pathology reports were included in analysis. The pre-COVID baseline number per quarter was 194; with 76 in 2020, 145 in 2021 and 77 in 2022. The proportion of pathology worse than intestinal metaplasia (IM) was 9.6% pre-COVID; and significantly higher at 17.1%, 17.2% and 50.7% in 2020, 2021 and 2022 respectively. A pattern of earlier detection of low grade dysplasia (LGD) was also seen over time. In 2015–2019, 28% of concerning pathologies were LGD. This fell in 2020 to 15.4%, then increased after the introduction of Cytosponge in 2021 and 2022 with proportions of LGD 52.0% and 53.9% respectively.

Conclusions The COVID-19 pandemic and introduction of Cytosponge resulted in higher yield of concerning pathologies. Within this cohort, a greater proportion of LGD was detected, suggesting that Cytosponge aids detection of earlier dysplastic changes.