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The national implementation of capsule sponge testing in Scotland has delivered significant improvements for the care of upper gastrointestinal patients. The testing programme launched in 2020 to improve the quality of care and diagnostic waiting times for patients with Barrett’s oesophagus and those at risk of oesophageal cancer.

The challenge

The onset of the COVID-19 pandemic interrupted Scotland’s endoscopy services, resulting in insufficient capacity to deliver timely procedures for patients requiring surveillance for Barrett’s oesophagus. Delays to surveillance increase the risk of cancer progression being missed until the later stages. This prompted the search for non-endoscopic options with strong clinical evidence, with NHS Scotland opting to use the capsule sponge test.

The solution

During the pandemic NHS Scotland began the national-level implementation of capsule sponge testing, to find a way to fast-track patients with signs of cancer for treatment and schedule patients at medium-to-low risk for their next surveillance procedure appropriately. As of January 2024, over 6000 tests have been performed throughout Scotland, with the test acting as a triage tool to identify patients requiring further investigation with endoscopy.

Key findings

Capsule sponge testing has cut patient waiting times significantly for NHS Scotland, while enriching endoscopy lists and boosting dysplasia detection rates to help clinicians identify more at-risk patients. This has released endoscopy resources for other complex procedures, such as bowel cancer screening.

• Using the test for screening has helped Scotland reduce the demand for follow up endoscopies by 77%.
• A national evaluation predicted cost savings of £700k in the first year and £3.3m over 5 years.
• NHS Scotland reduced median waiting times for endoscopy from 9 months to 5 months.
• From under 10% to over 50% concerning pathologies found at endoscopy.

Conclusion

By delivering high-quality care with fewer endoscopies, NHS Scotland has demonstrated what state-of-the-art Barrett’s surveillance could look like, prompting clinical teams across the UK and Europe to consider how to make a difference in the earlier detection of oesophageal cancer.

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