P254 Large single-site evaluation of cytosponge in a secondary care reflux service over 14 months

IntroductionUp to 6% patients with reflux may have underlying Barrett’s Oesophagus (BO) but only 20% patients with BO are diagnosed. The BEST3 study group established the value of Cytosponge as a non-invasive tool that picks up 10x more BO than routine practice in a primary care setting but this has not been assessed in secondary care. We established an early diagnosis and dyspepsia service during the pandemic to aid early diagnosis, management and appropriate triage to gastroscopy.MethodsAll patients waiting for direct access gastroscopy or referred to the clinical service with reflux symptoms were assessed in a nurse-run clinic and offered Cytosponge as a first test. We excluded patients with known BO, cancer, previous fundoplication and strictures. Patients were enrolled in the DELTA study or the ongoing NHSE pilot study. Patients found to be trefoil factor 3 (TFF3) +ve, a marker for intestinal metaplasia (IM), had routine endoscopy. Patients with atypia, p53+ve or dysplasia had 2ww gastroscopy. Patients with other significant findings or symptoms were offered gastroscopy and investigation as appropriate. All patients were given lifestyle and management advice.Results over 14 months 235 patients had successful Cytosponge procedures with adequate sampling. 29 patients (12%) had positive or equivocal TFF3, 215 (88%) had negative tff3. There were no significant adverse effects.3 (1.2%) patients had high risk biomarkers on Cytosponge: at gastroscopy 1 patient (p53 equivocal, atypia) had focal IM of the gastro-oesophageal junction but no BO/dysplasia. 1 Patient (p53+ atypia with inflammation) had a C4M5 BO biopsies showed regenerative atypia. 1 patient (focal p53+ squamous atypia) had a normal Lugol’s assessment and ENT review and had helicobacter gastritis. All will have repeat gastroscopy within 1yr.24/29 patients with TFF3+ have since had gastroscopy to date-13/24 (52%) had visible BO reported and will have ongoing surveillance as appropriate. This suggest around 6% of all patients had BO.66% patients did not require gastroscopy, 22% have gone on to have diagnostic gastroscopy for ongoing symptoms,12% for positive TFF3.154 (65.6%) of all patients with successful Cytosponge were discharged from follow up so far.ConclusionsWe report encouraging outcomes from the largest English site using Cytosponge in reflux patients in secondary care. Cytosponge detected pathology, aided decision making in a pandemic environment with limited resources and reduced unnecess