GPs could help catch cases of oesophageal cancer by offering a simple test to patients being treated for chronic heartburn.
An NHS study has been evaluating the use of EndoSign capsule sponge testing in GP surgeries and diagnostic hubs across the East of England, Lancashire and South Cumbria, and Wessex Cancer Alliance.
In the Cytoprime 2 project, GP records were used to contact and test 2,000 high-risk patients who had been on long-term PPIs but had not had an endoscopy.
The test which involves swallowing a capsule that dissolves in the stomach leaving a sponge which is pulled back out to collect cells from the oesophagus is then used to identify those with risk markers who can be referred for further tests.
Overall, the project identified 97 patients with Barrett’s oesophagus who need to be monitored more closely for cancerous changes and six cancers.
In addition 56 patients ended up with other diagnoses including gastritis and oesophagitis.
The results due to be presented at the British Society of Gastroenterology conference this summer also show cost savings for the areas the project was trialled.
Speaking with Pulse, Dr Peter Holloway, a GP in Suffolk and primary care lead of the East England Cancer Alliance said there are two ways in which the test could be used more readily in the community.
The first is for GPs to have direct access to the test in community settings such as community diagnostic centres where they are worried about symptoms patients are having.
‘We clearly demonstrated this was a safe test to do in a community whether that is a community diagnostic centre or a GP surgery. It is a safe easy test with a high degree of patient acceptability. The results are provided quickly and can rule out serious pathology.
‘If GPs referred every patient with reflux symptoms for endoscopy, the NHS would be overwhelmed. This is a test that GPs could refer to directly as an alternative to endoscopy.’
Direct access testing in this way is something NHS England is very interested in as a way of taking pressure off endoscopy services, he explained.
Making the test part of GP-led care pathways could also help address health inequalities by reaching patients who might not otherwise access specialist diagnostic services, the research team believe.
But the second way the test could be used is for proactive case finding in patients taking PPIs long term and that is continuing to be evaluated he added.
One example of a patient in the study was a 77-year-old man who had been living with chronic heartburn for decades.
The capsule sponge test done at his GP practice identified he had Barrett’s oesophagus, with a follow-up surveillance endoscopy showing it had progressed to high-grade dysplasia. He was referred for treatment to remove the precancerous cells and prevent cancer from developing.
Oesophageal cancer accounts for more than 9,000 new cases annually in the UK but around 80% are diagnosed too late to treat effectively.
‘By integrating these technologies into primary care, we can target those at risk, improve early cancer diagnosis rates and thus improve survival and outlook for our patients,’ Dr Holloway added.
