Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 4 experts were familiar with or had used this technology before.

Level of innovation

Three experts agreed that this technology is an innovative way to identify people who are at increased risk of having Barrett's oesophagus. Two experts noted that in primary care, people with reflux symptoms commonly had anti-acid medicines, and they were unlikely to be referred for endoscopy, leaving their Barrett's oesophagus undiagnosed. Currently, the standard way to diagnose Barrett's oesophagus is a gastroscopy and biopsy. All experts agreed that Cytosponge can be used as a screening or triage tool to identify people who need upper gastrointestinal endoscopy. One expert is aware of a similar device called EsophaCap but it is not CE marked and not available in the NHS. Another expert also noted that, compared with classic endoscopy, transnasal endoscopy is a slightly less invasive procedure and could be done in a community setting. However, it is more invasive than Cytosponge.

Potential patient impact

Early diagnosis of oesophageal cancer or identifying people who are at risk of developing oesophageal cancer is the main benefit identified by all experts. Cytosponge enables people to access diagnostics such as endoscopy earlier, especially for those with reflux disease. This leads to improved outcomes and treatment for people with oesophageal cancer. One expert considered that Cytosponge could also be useful to monitor eosinophilic oesophagitis. During the COVID-19 pandemic, Cytosponge could be a useful triaging test in secondary care for people with oesophageal symptoms. It may also be favoured by people who are reluctant to attend an endoscopy in hospital because of the risk of COVID-19. All experts agreed that people with reflux disease and other risk factors for Barrett's oesophagus such as obesity, smoking and family history would mostly likely benefit from the technology.

Two experts considered that Cytosponge should be incorporated in the pathway for management of gastro-oesophageal reflux disease in primary care.

Potential system impact

All experts thought Cytosponge could be cost saving to the NHS. One expert noted that the cost of the Cytosponge procedure itself is significantly lower than endoscopy. For instance, only 1 person is needed to administer Cytosponge (usually a nurse) compared with 1 doctor and 2 nurses, plus recovery nurses who are needed for endoscopy. Three experts considered that Cytosponge could improve NHS resource availability in secondary care. This is because it is given in primary care and enables targeted endoscopy with an improved pick-up rate of pathology.

One expert considered that Cytosponge is likely to lead to cost savings because early diagnosis of oesophageal cancer could have more curative treatment available. It could also reduce surgical and end of life treatment.

General comments

The experts noted that sore throat is common side effect after Cytosponge. Detachment is a possible severe adverse event but other adverse events are rare. The experts considered that Cytosponge is well tolerated and would be a lower-risk procedure compared with endoscopy. All experts agreed training is needed for primary care nurses who give treatment with Cytosponge. One expert thought the uptake would depend on the infrastructure in place to train practice nurses to give people treatment with the sponges, collect the sponges, process them and then give results in an accessible format.