Real world implementation of non-endoscopic triage testing for Barrett's oesophagus during COVID-19.

ABSTRACT

BACKGROUND: COVID-19 curtailed endoscopy services adding to diagnostic backlogs. Building on trial evidence for a non-endoscopic oesophageal cell collection device coupled with biomarkers (Cytosponge), a pilot implementation was launched for patients on waiting lists for reflux and Barrett's oesophagus surveillance. AIMS: 1) To review reflux referral patterns and Barrett's surveillance practices2) To evaluate the range of Cytosponge findings and impact on endoscopy services. DESIGN AND METHODS: Cytosponge data from centralised laboratory processing (Trefoil-factor 3 (TFF3) for intestinal metaplasia (IM), H&E for cellular atypia, and p53 for dysplasia) over a 2-year period were included. RESULTS: 10,577 procedures were performed in 61 hospitals in England and Scotland, of which 92.5% (N = 9,784/10,577) were sufficient for analysis. In the reflux cohort (N = 4,074 with GOJ sampling), 14.7% had one or more positive biomarkers (TFF3 13.6% (N = 550/4,056), p53 0.5% (21/3,974), atypia 1.5% (N = 63/4,071)) requiring endoscopy. Among samples from individuals undergoing Barrett's surveillance (N = 5,710 with sufficient gland groups), TFF3-positivity increased with segment length (OR = 1.37 per cm (95% CI 1.33-1.41, p < 0.001)). 21.5% (N = 1,175/5,471) of surveillance referrals had ≤1cm segment length, of which 65.9% (707/1,073) were TFF3 negative. 8.3% of all surveillance procedures had dysplastic biomarkers (4.0% (N = 225/5,630) for p53 and 7.6% (N = 430/5,694) for atypia), increasing to 11.8% (N = 420/3552) in TFF3+ cases with confirmed IM and 19.7% (N = 58/294) in ultra-long segments. CONCLUSIONS: Cytosponge-biomarker tests enabled targeting of endoscopy services to higher-risk individuals, whereas those with TFF3 negative ultra-short segments could be reconsidered regarding their Barrett's oesophagus status and surveillance requirements. Long term follow-up will be important in these cohorts.