We are always looking for innovative ways to provide the best possible care for the people of Lancashire and South Cumbria.
New developments, such as the capsule sponge test, mean that we can offer early diagnostic investigations in a much less invasive way, sometimes without the need to attend a hospital. This new technology can help us to manage endoscopy waiting lists and prioritise the patients that are most in need.
Many patients who would normally be followed up for Barrett’s oesophagus or investigated for reflux symptoms using traditional endoscopy may now be offered this alternative test.
This has been made possible by our collaboration with Cyted Ltd and the Health Innovation North West Coast.
What is Capsule sponge?
Capsule sponge tests are a new diagnostic test being introduced by the NHS to identify important oesophageal conditions such as Barrett’s oesophagus.
Identifying cell changes with the test is crucial to ensure conditions such as Barrett’s do not progress to become oesophageal cancer. The test allows cell changes to be identified and simple, curative treatment to be offered.
Capsule sponge devices (such as the Cytosponge and EndoSign devices) consist of a small capsule which is attached to a fine thread.
After swallowing, the capsule coating (vegetarian gelatin) dissolves in the stomach over seven minutes to release a small sponge which, when removed, allows cell collection from the lining of the oesophagus (gullet or food-pipe). These cells are then analysed for abnormal findings.
The test itself is performed over a 30-minute appointment and has been found in several studies to be safe, well-tolerated and effective.
Why are capsule sponge tests used?
It's common to suffer from heartburn and acid reflux, but this can occasionally lead to changes in the normal cells within your oesophagus (gullet) causing a condition called Barrett's oesophagus.
Very occasionally, Barrett's oesophagus may develop pre-cancerous or cancerous changes which may lead to oesophageal cancer (cancer of the gullet).
Early detection of cell changes (dysplasia) in Barrett's oesophagus can make treatment much easier and more effective, with better patient outcomes.
A capsule sponge test allows your doctor to investigate any symptoms and helps to manage them.
Benefits of the test include that it...
● is quicker than an endoscopy,
● is less invasive than an endoscopy,
● does not require sedation,
● can provide results quickly,
● can be delivered in a non-hospital setting,
● is cheaper for the NHS than an endoscopy,
● does not have to be delivered by a nurse endoscopist,
● has a lower carbon footprint than endoscopy.
Within Lancashire and South Cumbria, the test has been used in the following three projects.
NHS England Pilot
Lancashire Teaching Foundation Trusts is participating in the NHS England Pilot, delivering the test in a hospital setting for patients with an existing diagnosis of Barrett’s oesophagus. Patients receive the test instead of their regular endoscopy which is required to monitor their condition.
If the test finds that the patient is experiencing changes in their cells then they receive a follow-up endoscopy for further investigation.
Picture, top, courtesy of Medtronic
In 2022 we were privileged to participate in the CYTOPRIME1 project, which was made possible by funding from SBRI Healthcare. This project, led by Cyted, saw the capsule sponge test being delivered at GP practices in Lancashire and South Cumbria and Cheshire and Merseyside, a new application of the test.
As with the NHS England pilot, the test was being offered to patients with an existing diagnosis of Barrett’s oesophagus as an alternative to the endoscopy which they would receive as part of their regular monitoring.
One hundred and ten patients were tested in Lancashire and South Cumbria; in Barrow-In-Furness, Blackpool, Burnley and Oswaldtwistle. The project was evaluated by Unity Insights who summarised the following key outcomes in our area:
● 101 endoscopies were avoided.
● Nine patients were prioritised for urgent endoscopy.
● There was a 31 per cent reduction in patients waiting more than six weeks from referral to procedure.
● 81 per cent of patients who responded to a survey said they would have the test again.
● The project proved that if the test was delivered to 1500 patients over five years, then there would be savings to the NHS of £250,880.
Thanks to funding provided by the Cancer Alliance, following the end of the project we have been able to extend the delivery of the service in Barrow-In-Furness, Burnley and Oswaldtwistle.
Following CYTOPRIME1, we have continued our work with Cyted with a further capsule sponge project, this time, joined in partnership with the East of England Cancer Alliance and Wessex Cancer Alliance. The project runs from February 2023 to July 2024.
In CYTOPRIME2, a further five clinics have been established in GP practices. In all eight clinics, the capsule sponge test is now being proactively offered to patients with chronic reflux symptoms as a heartburn healthcheck.
The patients are being identified via searches of GP practice databases, with the following criteria:
● Patients must be over 50 years of age
● Patients must have been on Proton Pump Inhibitor (PPI)medication (such as omeprazole and lansoprazole) for their acid reflux symptoms for at least six months.
● Patients must not have an existing diagnosis of Barrett’s oesophagus, have received an endoscopy in the past five years, or have received treatment to their oesophagus (gullet) in the past.
Other exclusion criteria also apply, which are discussed by the practice nurse with the patient over the phone. The test is being used to determine if the patient’s chronic reflux symptoms could indicate that the patient has Barrett’s oesophagus or oesophageal cancer. If the sponge sample appears to indicate either of these conditions, then the patient would then be referred for an endoscopy.
This project is also funded by SBRI Healthcare and the NHS England Cancer Programme, with funding enabling the test to be delivered at a limited number of practices in the region, including:
● Abbey Road Surgery
● Bridgegate Medical Centre
● Duke Street Surgery
● Norwood Medical Centre
● Lancaster Medical Practice
● Burnley Group Practice
● Oswald Medical Centre
● Waterfoot Medical Practice
Currently, patients at other practices in the region are not yet able to receive the test or self-refer.
Find out more about Barret's oesophagus, heartburn or oesophageal cancer
They advise that you should contact your GP immediately if you have any of the following:
● Pain or difficulty when swallowing.
● Food getting stuck in your oesophagus.
● Frequently being sick.
● Unintended weight loss.
● Persistent heartburn despite medication.
Cancer Research UK Science Blog Case Study - A Sponge On A String To Detect Oesophageal Cancer Earlier
SBRI Healthcare Case study on CYTOPRIME1- The capsule sponge test transforms patient outcomes from oesophageal cancer by finding people at risk earlier and faster
Lancaster Guardian article on CYTOPRIME2 - Funding boost for innovative cancer test will help patients in Lancaster