Capsule Sponge Triage for Reflux

This large, single-center, prospective cohort study evaluated a non-endoscopic capsule sponge (CS) triage pathway for patients routinely referred with reflux symptoms over 4 years. The goal was to assess its impact on endoscopy utilisation, diagnostic yield, and long-term safety.

Among 871 patients who underwent capsule sponge testing, nearly 88% provided adequate samples. Importantly, 62% avoided endoscopy, and most of these low-risk patients were safely discharged. Abnormal CS results were seen in approximately 10% of patients and were strongly associated with significant pathology. One case of esophageal cancer, two cases of Barrett’s dysplasia, and 34 cases of Barrett’s esophagus were detected. The positive predictive value for Barrett’s esophagus in patients with abnormal CS was 43.5%, while the negative predictive value was high at 98.2%.

Long-term follow-up (over 2,000 patient-years) confirmed safety. Only a small proportion of patients with a negative CS who later underwent endoscopy for persistent symptoms were found to have Barrett’s or atrophic gastritis. Patient acceptability was excellent, with over 97% finding the test acceptable.

Overall, the capsule sponge pathway safely stratifies reflux patients, increases the yield of significant endoscopic diagnoses, reduces unnecessary procedures, and supports more efficient endoscopy resource utilization.