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P270 The introduction of cytosponge to NHS Scotland: initial reports

Introduction In recent years, endoscopy services throughout NHS Scotland were under substantial strain due to supply/ demand mismatch: these pressures were significantly exacerbated by the COVID-19 pandemic, which saw cessation of all routine and surveillance endoscopies. Cytosponge is a nonendoscopic diagnostic tool demonstrating good specificity and sensitivity for detection of Barrett's oesophagus and dysplasia in the trial setting. Cytosponge was introduced as a triage tool in a real world pilot across NHS Scotland in 2020 under closely audited conditions in response to the COVID-19 pandemic. This presents the initial results of this audit. Methods A national Cytosponge group was formed with representatives from all Scottish health boards and the Scottish government. The two indications for Cytosponge were: Barrett's oesophagus surveillance patients;and new referrals with reflux-predominant symptoms. Cytosponge was introduced in the secondary care setting following appropriate nurse training, with data collected from September 2020 to January 2022. Indications and cytology codes were obtained from Cyted Labs. Results During the study period, Cyted Labs received 3180 specimens from NHS Scotland;3020 of these were formally reported. Indication for Cytosponge was Barrett's surveillance in 2271 samples (75.2%) and reflux symptoms in 749 samples (24.8%). Within the Barrett's oesophagus cohort, 143 samples (6.3%) did not provide adequate cells for analysis. of the remaining 2128 patients, 246 samples (11.6%) demonstrated cellular atypia or aberrant p53 expression and 1425 samples (67.0%) showed simple Barrett's oesophagus. of interest, 457 samples (21.5%) in the Barrett's surveillance group did not demonstrate intestinal metaplasia. Full results for patients with reflux-predominant symptoms were available in 679 samples;70 samples (9.3%) did not yield adequate cells for cytology. Intestinal metaplasia was identified in 83 samples (12.2%), with an additional 23 specimens (3.4%) demonstrating atypia or aberrant p53 expression. Conclusions Cytosponge is a useful diagnostic tool to demonstrate pathology in cohorts of patients unable to access endoscopy during the COVID-19 pandemic due to service pressures. Our initial results give an indication of endoscopy resources required to support Cytosponge;with only 11.6% of Barrett's oesophagus surveillance patients and 15.6% of reflux patients requiring endoscopy to exclude adenocarcinoma or precursor lesions. This significantly reduces the burden on endoscopy services. The study does not describe patients undergoing endoscopy for reflux with other pathologies. However, early results suggest that Cytosponge, combined with nurse-led clinical assessment, is beneficial in these patient pathways.