How fully managed insourced services are delivering capsule sponge testing: The future of oesophageal health

Faced with rising waiting lists and a lack of staff resources, the NHS’s gastroenterology service is in dire need of innovation to combat its pressures.

Challenges exacerbated by the COVID-19 pandemic and pre-existing issues within the GI endoscopy landscape, such as inefficient patient selection, rising demand, and workforce challenges, resulted in an approximate 95% reduction in surveillance activities and routine gastroscopies in that period.

The situation for patients is still far from ideal; there are currently over 17,056 people waiting over six weeks for a gastroscopy procedure across England, with 54% of those waiting over 13 weeks.

These issues catalysed the NHS to publish guidance on establishing Gastrointestinal (GI) Endoscopy Networks in England for 2023/24, seeking a comprehensive overhaul of the existing endoscopy services across the healthcare system.

Endoscopy services are poised for significant transformation, driven by technological advancements and pathway support through industry-leading, fully managed insourcing services. This transformation is supported by targeted government investment to upgrade facilities, enhance workforce capabilities, and implement new technologies.

Early cancer detection and treatment with capsule sponge testing

Cyted’s EndoSign® capsule sponge test is at the forefront of this innovation, representing a groundbreaking advancement in the early detection of oesophageal cancer and Barrett’s oesophagus.

A pioneering diagnostic tool, the capsule sponge test offers a minimally invasive way to identify patients with an increased risk of developing oesophageal cancer, particularly those with chronic reflux symptoms or diagnosed with Barrett’s oesophagus. Identifying at-risk patients who need further endoscopic investigation, and diverting those who don’t, eases the pressure on endoscopy services, and releases resources across the patient care pathway.

How it works:

1. Swallowing the capsule: Initially, the patient swallows a capsule, similar in size to a vitamin pill, which is tethered to a strong, thin thread. This process is simple and facilitated by drinking water, making the capsule easy to ingest.
2. Capsule dissolves: Once the capsule reaches the stomach, its outer layer dissolves to release a small sponge.
3. Sponge expansion and retrieval: The clinician pulls the string, and the sponge collects cells as it passes through the oesophagus.
4. Cell analysis: The retrieved sponge containing a sample of oesophageal cells is sent to Cyted Health’s laboratory. The samples are analysed for any abnormalities and indications of oesophageal cancer or its precancerous condition, Barrett’s oesophagus.

What are the benefits?

• Non-invasive – avoiding sedation enhances patient comfort and convenience, removing the discomfort and anxiety associated with conventional endoscopic examinations.
• Efficiency – the test requires approximately just 10 minutes to complete across all outpatient settings. This enables more sites and more staff to offer the test, helping further reduce wait times.
• Early detection – catching Barrett’s oesophagus and oesophageal cancer early greatly increases the chances of successful treatment and patient survival. This is crucial for oesophageal cancer as 81% of patients are diagnosed late (at stages 3-4) where survival rates are below 20% beyond the year of diagnosis.
• Cost-effectiveness – the capsule sponge test can lead to considerable savings and better allocation of healthcare resources by eliminating the need for unnecessary endoscopies and other traditional diagnostic processes.

How our fully managed insourcing service can compound the benefits of capsule sponge testing

Over the last 15 years, endoscopy has consistently ranked among the top three clinical specialities sought for insourcing, witnessing substantial improvements in patient safety, cost efficiency, patient outcomes and experiences, and contract management.

The increased expertise of trusts in managing insourcing contracts, the growing competitive market, and the Joint Advisory Group (JAG) guidelines on endoscopy insourcing have all contributed significantly to these advancements. However, insourcing requires trusts to maintain operational and clinical oversight while utilising their premises and equipment with external teams.

To mitigate these issues, we have partnered with Cyted Health to deliver our industry-leading managed service in conjunction with their innovative capsule sponge testing technology. This provides trusts with crucial capacity, flexibility and access to specialist workforce and equipment.

This service is an alternative pathway for patients who require endoscopic evaluation, particularly due to chronic reflux symptoms or surveillance of Barrett’s oesophagus. Here’s how the service operates:

1. Triage: Patients with chronic reflux symptoms or those under surveillance for Barrett’s Oesophagus are identified from the NHS backlog for routine endoscopy referrals. Those not suitable for the capsule sponge test are filtered out.
2. Capsule sponge procedure: Eligible patients undergo the capsule sponge test, managed by our expert teams, which includes swallowing a capsule that collects oesophageal cell samples.
3. EndoSign® diagnostic test at Cyted Health: The collected samples are then sent to Cyted Health for the EndoSign® diagnostic test to analyse for any abnormalities.
4. Follow-Up: Post-analysis, our clinicians follow up with the patient based on the pathology report.
5. Outcome-based actions: If the result is positive (in approximately 15-20% of cases), the patient is referred for an endoscopy. If the result is negative (in about 80% of cases), the patient is managed safely according to their symptoms without endoscopy.

This fully managed service streamlines the patient journey by integrating triage, testing, analysis, and follow-up, effectively addressing the backlog while ensuring patients receive the appropriate level of care based on their test results.

The future of oesophageal health

The deployment of the capsule sponge test in over 60 hospitals and 20 community care-based clinics throughout the UK has already demonstrated substantial benefits. The ease of implementation and integration into current healthcare pathways underscores its potential as a transformative tool in managing gastrointestinal diseases.

Combined with our insourcing services, saving NHS Trusts crucial clinical capacity with no disruption to existing workforces, our co-developed service with Cyted Health offers a promising avenue for reducing costs and waiting lists while improving cancer surveillance and patient care at scale.

For more information, please contact Nicola Ellis-Webb, Healthcare Service Director at Acacium Group, via email at nicola.elliswebb@acaciumgroup.com.