O15 Impact of introduction of a cytosponge barrett’s oesophagus surveillance service on the endoscopic pathology pattern

• Published in: Gut Vol. 72; no. Suppl 2; pp. A7 - A8
• Main Authors: Yan Tung Natalie Tse, Glen, Paul, Chien, Siobhan
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: Biopsy; COVID-19; Dysplasia; Endoscopy; Esophagus; Metaplasia; Pandemics; Pathology; Surveillance
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2023-BSG.15

IntroductionAn endoscopic Barrett’s Oesophagus (BO) surveillance programme uses significant endoscopic resource but will detect early changes of dysplasia; Cytosponge was introduced in Scotland as an emergency response to the COVID-19 pandemic when endoscopy was not available. We describe the impact of Cytosponge for BO surveillance on our endoscopic biopsy pathology pattern.MethodsA prospectively maintained database of all pathology reports coded as BO from 2015 to present was interrogated. The same sample three-month period from each calendar year was selected and worst pathology was recorded. The years 2015 to 2019 inclusive were designated pre-COVID years as a baseline for our service. Cytosponge was introduced after the 2020 study sample.ResultsIn the study period, 1268 pathology reports were included in analysis. The pre-COVID baseline number per quarter was 194; with 76 in 2020, 145 in 2021 and 77 in 2022. The proportion of pathology worse than intestinal metaplasia (IM) was 9.6% pre-COVID; and significantly higher at 17.1%, 17.2% and 50.7% in 2020, 2021 and 2022 respectively. A pattern of earlier detection of low grade dysplasia (LGD) was also seen over time. In 2015–2019, 28% of concerning pathologies were LGD. This fell in 2020 to 15.4%, then increased after the introduction of Cytosponge in 2021 and 2022 with proportions of LGD 52.0% and 53.9% respectively.ConclusionsThe COVID-19 pandemic and introduction of Cytosponge resulted in higher yield of concerning pathologies. Within this cohort, a greater proportion of LGD was detected, suggesting that Cytosponge aids detection of earlier dysplastic changes.