Diagnostic test to divert patients from traditional endoscopy services

Cytosponge is a tiny sponge in a capsule on a thread which the patient swallows. The capsule dissolves and the sponge collects oesophageal cells when withdrawn.

It is offered to patients with reflux and Barrett’s oesophagus, a condition which can lead to oesophageal cancer. The device can help divert patients away from endoscopy services.

Stephanie Driver, Practice Manager at Oswald Medical Centre in Lancashire

The Innovation Agency played a key role in helping secure close to £500,000 SBRI Healthcare funding – an Accelerated Access Collaborative initiative in partnership with the AHSN Network – for the Cytoprime project. This brought together primary and secondary care teams, endoscopy networks and industry partner Cyted to offer the Cytosponge diagnostic test to patients with reflux and Barrett’s oesophagus in a community setting.

The aim was to divert demand away from hard-pressed hospital endoscopy teams. Endoscopy waiting lists are very long – the North West Coast has some of the longest waiting times in the country – and have been exacerbated by the pandemic.

The Cytosponge tests needs only a short appointment and is generally more comfortable for patients.

The Cytoprime project covered two Integrated Care Systems; Lancashire & South Cumbria (L&SC) and Cheshire & Merseyside (C&M). In L&SC there were three hospital trusts: East Lancashire Hospitals NHS Trust, University Hospitals of Morecambe Bay NHS FT and Blackpool Teaching Hospitals NHS FT. It also involved four primary care sites: Oswald medical practice in Accrington, Burnley group practice, Morecambe Bay Primary Care Collaborative and Fylde Coast Medical Services. In C&M the project built upon the national NHS England pilot at St Helens and Knowsley Teaching Hospitals NHS Trust and St Helens Community Diagnostic Centre.

The Innovation Agency’s Patient and Public Involvement team were involved with the pilot from the start. Its patient representatives suggested that ‘sponge on a string’ was a phrase likely to deter patients and should be replaced with ‘sponge on a thread’. To obtain vital patient feedback the team developed patient questionnaires and held numerous one to one conversations with patients.

Analysis of the pilot showed that:

• The backlog of Barret’s surveillance patients waiting for endoscopies at the three Lancashire Trusts has been cleared
• 77% of reflux patients were discharged from the endoscopy list, while 10% of patients under surveillance for Barrett’s oesophagus were removed from the list
• 89% of those who had the test said they would have it again.

St Helens and Knowsley report that they cleared their entire backlog of 300 patients awaiting endoscopies for Barrett’s oesophagus and were bringing patients forward.

There is widespread evidence that patients prefer the Cytosponge procedure to an endoscopy.