Introducing Capsule Sponge Tests in Wales (Powys)

Powys Teaching Health Board has successfully concluded a series of clinics using the EndoSign® capsule sponge test for the ongoing surveillance of patients with Barrett's Oesophagus, a precancerous condition.

Late-stage diagnosis of oesophageal cancer is common, with diagnostic challenges including non-specific symptoms that overlap with more common benign conditions. However, early detection significantly improves survival rates - 63% of patients diagnosed at stage 1 survive for five 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. Within 10 minutes, the sponge is gently pulled back up, collecting oesophageal cells as it is withdrawn.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

Conducted over six months from 2023 into 2024, the nurse-led clinics in Powys provided capsule sponge tests to 41 patients. Some had previously declined surveillance gastroscopy due to discomfort. However, they successfully underwent the sponge test, which provided valuable diagnostic insights and enabled some patients to be discharged altogether and others to be placed on a 5-year monitoring interval. Importantly, the results enabled a number of patients to be fast-tracked for gastroscopy, ensuring they received timely diagnosis and treatment.

The work in Powys 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 it has been implemented across all mainland health boards for this use case. Evaluation of Scotland’s work 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.

The endoscopy team in Powys is ready to incorporate this patient friendly diagnostic into their standard surveillance pathway once Welsh national guidance is issued.

Learn more about how our support facilitated the implementation of capsule sponge testing in North Wales.