The Innovation Agency supported the pilot of an innovative diagnostic test, delivered in community settings, that aims to divert patients away from hard-pressed hospital endoscopy services.
Endoscopy waiting lists are very long and the North West Coast has some of the longest lists in the country. The challenge was to reduce lists by administering a diagnostic test in the community that would alleviate pressures on endoscopy teams.
The Innovation Agency played a key role in securing £500,000 of SBRI Healthcare funding for the pilot of a diagnostic test called Cytosponge™. The Cytosponge™ device was developed by a team of researchers at the University of Cambridge and is now produced by Medtronic. It is a small sponge in a capsule that the patient swallows. The capsule dissolves and the sponge is withdrawn on a thread, gathering oesophageal cells. The cells are analysed by Cyted, a Cambridge-based AI and diagnostic specialist.
The test is designed for patients with reflux and Barrett’s oesophagus, a condition in which the oesophagus becomes inflamed and which can lead to cancer.
The test is much quicker and generally more comfortable for a patient than an endoscopy, which can require several hours of staff time.
The Cytoprime project featured the Lancashire and South Cumbria Integrated Care System (ICS) and the Cheshire and Merseyside ICS. In Lancashire and South Cumbria there were three hospital trusts: East Lancashire Hospitals NHS Trust, University Hospitals of Morecambe Bay NHS FT and Blackpool Teaching Hospitals NHS FT. It also involved four primary care sites:
Oswald medical practice in Accrington, Burnley group practice, Morecambe Bay Primary Care Collaborative and Fylde Coast Medical Services.
In Cheshire and Merseyside the project built on the national NHS England pilot at St Helens and Knowsley Teaching Hospitals NHS Trust and St Helens Community Diagnostic Centre.
Role of the Innovation Agency
The Innovation Agency secured the funding for the pilot and its Patient and Public Involvement team were involved from the start. Its patient representatives suggested that ‘sponge on a string’ was a phrase likely to deter patients and should be replaced with ‘sponge on a thread’. To obtain vital patient feedback the team developed patient questionnaires and held numerous one-to-one sessions with patients.
The pilot aimed to treat patients in primary care settings and so ease pressures on endoscopy services. Analysis showed:
• The backlog of Barrett’s surveillance patients waiting for endoscopies at the three Lancashire trusts has been completely cleared
• 77 per cent of reflux patients were discharged from the endoscopy list, while 10 per cent of patients under surveillance for Barrett’s oesophagus were
removed from the list
• 89 per cent of those who had the test said they would have it again
St Helens and Knowsley report that they cleared their entire backlog of 300 patients awaiting endoscopies for Barrett’s oesophagus and were bringing patients forward.
Tony Bayliss, patient:
“I prefer the sponge because it’s much quicker and it’s very simple. I was a bit hesitant to start with but it was no bother at all in the end and I’d recommend it to anyone.”
Stephanie Driver, practice manager at Oswald medical centre in Lancashire:
“Our first reaction was: Why hasn’t anyone thought of this before? Our patients’ reaction was overwhelmingly positive when we offered Cytosponge™ as an alternative procedure.”
Consultant gastroenterologist Dr David McClements:
“I’m sure the test will become part of standard guidelines and the more we increase the evidence base the more widely accepted it will become.”
In Lancashire the project has been extended and funding is being secured to offer the test until spring 2024.