Impact on Barrett's dysplasia yield following the introduction of capsule sponge testing versus traditional endoscopic surveillance.

Background: Capsule sponge testing for Barrett's surveillance is emerging as an innovative technology to aid endoscopic surveillance programs but has yet to be compared to traditional endoscopy in clinical practice. This study aims to establish the impact of the introduction of capsule sponge testing on dysplasia detection rates.

Methods: Over a 5-year period, data were collected for all patients undergoing endoscopy and capsule sponge testing for Barrett's surveillance in a single health board. The 2-year periods pre- and post-implementation of capsule sponge testing were compared to assess dysplasia yield. Patients undergoing surveillance over the 2-year period 1 January 2021 to 31 December 2022 were dichotomized into two groups: capsule sponge test (±subsequent endoscopy) versus endoscopic surveillance only, to compare endoscopic biopsy results.

Results: Barrett's surveillance was performed in 1568 patients between 1 January 2018 and 31 December 2019 (pre-intervention group) versus 1791 patients between 1 January 2021 and 31 December 2022 (implementation group). In the implementation group, 871 patients underwent traditional endoscopy versus 920 patients undergoing capsule sponge testing (with 157 patients [17.1%] proceeding to endoscopy after capsule sponge test). There were no significant differences in the rates of high grade dysplasia (HGD), intramucosal cancer (IMC), or invasive cancer diagnosed between the groups. However, yield of indefinite for dysplasia and low grade dysplasia (LGD) cases was higher in the endoscopic surveillance cohort.

Conclusions: Capsule sponge testing is non-inferior to traditional endoscopic surveillance for detecting HGD, IMC, and cancer. Further follow-up is required to ensure early dysplasia is diagnosed appropriately in those undergoing capsule sponge testing for Barrett's surveillance.