Reflux symptoms are highly prevalent and non-specific hence, in the absence of alarm symptoms, endoscopy referral decisions are challenging. This study evaluated whether a non-endoscopic Cytosponge could detect benign oesophageal pathologies and thus have future potential in triaging patients with persistent symptoms.
Two complementary cohorts were recruited: 1) Patients with reflux symptoms and no prior endoscopy (n=409); 2) Patients with reflux symptoms referred for endoscopy (n=411). All patients were investigated using the Cytosponge and endoscopy. Significant epithelial inflammation was present in 130 (16%) Cytosponge samples of which 32 had ulcer slough. Candida and significant inflammation was detected in a further 22 (2.3%) cases; epithelial infiltration with >15 eosinophils/hpf reflecting possible eosinophilic oesophagitis (EOE) in five (0.6%); and viral inclusions suggestive of herpes oesophagitis in one (0.1%). No significant pathology was detected in the majority, 662 (81%), of Cytosponge samples. Cytosponge and endoscopy findings were in agreement in 574 (70%) cases, in most discordant cases, 165 (67%), one investigation showed mild inflammation whilst the other was negative; with an additional 22 (8.9%) differing on the inflammation extent. Eighteen cases with severe inflammation, six with candida and two with EOE were detected only at endoscopy; whilst 18 with candida and significant inflammation, 13 with ulcer slough, one probable EOE, and one viral oesophagitis were identified on the Cytosponge only.
The Cytosponge detects a range of benign oesophageal pathologies, and therefore has potential clinical utility in the triaging of patients with troublesome reflux symptoms. This warrants further investigation. This article is protected by copyright. All rights reserved.