Changing Strategy for Barrett's Surveillance: Using Cytosponge and Gastroscopy over 14 Months during Covid19

ABSTRACT

Introduction: Pandemic restrictions delayed endoscopic Barrett's surveillance programmes with a risk of late or missed dysplasia and cancer diagnoses. We established a new Cytosponge service and surveillance pathway to address this risk and aid triage of patients to timely gastroscopy alongside gastroscopic assessment for higher risk patients. Aims & Methods: East and North Hertfordshire NHS Trust covers a population of 600,000 people. We have 700 patients on our Barrett's surveillance database.All patients due or overdue surveillance from November 2020 to January 2022 were offered Cytosponge instead of gastroscopy unless contraindicated, or previous history of Dysplasia or oesophageal cancer. Contraindications included strictures, varices and fundoplication - as such, patients with these conditions, as well as those declining or failing Cytosponge, were offered gastroscopy.TFF3 was used as a biomarker for intestinal metaplasia (IM). P53 positivity and atypia were biomarkers for potential dysplasia.33 patients were also included in the DELTA study. Result(s) 230 patients were included in the study.152 patients successfully swallowed Cytosponge with adequate cytology. 78 patients had gastroscopy as a primary surveillance method. Of the Cytosponge group, 115/152 (76%) patients had positive biomarkers - 97(64%) were solely TFF3 positive (suggesting non dysplastic Barrett's oesophagus). 18 (12%) had atypia and/or p53 positive (suggesting dysplasia). 37 (24%) were TFF3 negative and are described elsewhere. Confirmed dysplasia at endoscopy was found in 8/18 patients with atypia/p53 positivity on Cytosponge. 2 patients were found to have evidence of high grade dysplasia, 5 has evidence of low grade dysplasia, and one sample was 1indefinite for dysplasia.5% overall confirmed dysplasia. Of the gastroscopy group, 8/78 (10%) were found to have dysplasia, 2 patients had high grade dysplasia, 2 had low grade displasia and 4 were indefinite for dysplasia. In total, 16/230 (7%) had histologically confirmed dysplasia during the pandemic. Conclusion(s) We were able to prevent delayed Barrett's surveillance during the COVID-19 pandemic using Cytosponge in most patients and reduce unnecessary gastroscopy. Using a combination of Cytosponge in low risk and gastroscopy in higher risk patients for Barrett's surveillance during the pandemic allowed identification of dysplasia.Further stratification of risk using Barrett's length, Male sex and age have been identified from the recently reported DELTA study which may further improve dysplasia detection by identifying those in the Cytosponge group who need more frequent surveillance. Comparison with non-pandemic years going forward will also be important to evaluate this strategy.