Capsule sponge tests are now an established part of routine care in North Wales. This minimally invasive alternative to upper GI endoscopy is now a permanent part of the pathway for patients under surveillance for Barrett’s oesophagus, a pre-cancerous condition.
Late-stage diagnosis of oesophageal cancer is common, with diagnostic challenges including non-specific symptoms that overlap with more common benign conditions. If detected at an earlier stage, oesophageal cancer survival is higher, with 63% of people diagnosed at stage 1 surviving for 5 years or more. Not all patients with Barrett’s Oesophagus will develop cancer, but surveillance helps identify those at higher risk, ensuring timely intervention while avoiding unnecessary procedures for low-risk individuals.
Capsule sponge tests offer a minimally invasive, non-endoscopic way to sample cells from the oesophagus lining. The procedure requires no sedation or local anaesthetic and can be done in an outpatient setting in just 15–20 minutes, using fewer resources than a diagnostic upper GI endoscopy.
The device consists of a tiny sponge enclosed in a capsule with a string attached. After swallowing it with water, the capsule dissolves in the stomach, releasing the sponge. Less than 10 minutes later, the sponge is gently pulled back up, collecting oesophageal cells as it is withdrawn. These are then tested for cell changes that may be a precursor to oesophageal cancer
Over a 12-month period at Wrexham Maelor Hospital, nurse-led implementation clinics provided capsule sponge tests to just over 100 patients previously diagnosed with Barrett’s oesophagus. Patients with a positive result were referred for further investigation via an endoscopy, while patients with a negative result were returned to the surveillance list without the need for further testing. Moving forward, routine surveillance for patients in North Wales will continue, alternating sponge tests with endoscopies.
The work in North Wales adds to growing evidence base that capsule sponge tests are a safe, tolerable and effective option for surveillance of Barrett's Oesophagus. Betsi Cadwaladr University Health Board is the first in Wales to adopt this technology, following Scotland’s lead, where capsule sponge testing has been implemented across all mainland health boards for this use case. The evaluation of the work in Scotland has reported:
- a significant reduction in endoscopy demand
- that capsule sponge successfully identified high risk patients for further investigation
- evidence of reduced waiting times for high-risk patients between final surveillance endoscopy and start of treatment.
- that cost-savings were identified compared to usual care.
We have also supported Powys Teaching Health Board to introduce capsule sponge tests. Find out more about that work here.