Professor Grant Fullarton – OPA Trustee

Grant has taken up an advisory post with the Scottish Government as the Clinical Lead for General Surgery. Grant has managed to introduce the Cytosponge in NHS Scotland as a National Service. The Cytosponge, now known as EndoSign, is a new technique to screen Barrett’s oesophagus patients.

Grant is the former lead Oesophago-Gastric Consultant Surgeon in Glasgow Royal Infirmary with major interests in management of malignant and complex benign upper GI disease. Grant is a former Associate Professor of Clinical Surgery with extensive research interest in benign and malignant upper GI disease. His particular interest is in the field of Barrett’s oesophagus including its role in cancer development and treatment with Radiofrequency Ablation.

Scotland to become first country to offer widespread capsule sponge testing for the detection of oesophageal cancer and Barrett’s oesophagus

• EndoSign® capsule sponge technology allows patients suffering from heartburn to get a quick and easy diagnosis of oesophageal cancer and Barrett’s oesophagus
• Sponge capsule can also be used to risk stratify known Barrett’s cases allowing identification of serious pathology with significant reduction in endoscopy requirements 
• Over 4,000 capsule sponge tests were performed during the pilot programme, increasing concerning test results found at endoscopy from under 10% to over 50% 

NHS Scotland through the CytoScot program  has introduced the national adoption of capsule sponge test technology across all 14 health boards. The test is currently available to patients in secondary care with known Barrett’s oesophagus or severe reflux where there is suspicion of Barrett’s or early cancer .  This will ensure the early diagnosis of oesophageal cancer and Barrett’s oesophagus is readily available to patients across Scotland.

The capsule sponge test takes less than ten minutes and can help ensure that oesophageal cancer and precancerous conditions are quickly detected and treated. It will vastly improve the availability of vital diagnostic services for patients suffering from chronic heartburn, which could be a sign of Barrett’s oesophagus, a condition that carries a high risk of developing oesophageal cancer. 

Patients swallow a capsule the size of a multivitamin pill containing a small sponge on a strong thread, which collects cell samples for analysis. The test reduces the need for invasive endoscopies which can often require a lengthy hospital visit and sedation, limiting access for certain patients. Patients have found the sponge test to be simple and more acceptable than endoscopy.

Capsule sponge testing has helped provide more targeted care for patients, cutting waiting times and boosting clinical capacity as demand for endoscopy is reduced and detection rates increase. In addition there are major health economic benefits with significant cost savings by moving to a capsule sponge diagnostic service.

Patients suffering from persistent heartburn, or indigestion should be aware that these could be symptoms of Barrett’s oesophagus, or even oesophageal cancer, and should speak with their GP about being referred for a capsule sponge test. 

Many patients currently have to travel long distances to receive an endoscopy, but the option of taking the capsule sponge test, which can be delivered in community settings closer to home, means that unnecessary travel can be avoided if Scotland chooses to offer the service in primary and community care.

In 2020, gastrointestinal health company Cyted and NHS Scotland launched a pilot programme with the goal of detecting oesophageal cancer at an earlier stage, reducing the demand for endoscopy services and improving patient access to vital diagnostic services. Approximately 4,000 tests were delivered during the four-year programme. As a result of the improvements to patient triage, 1 in 2 endoscopies now find concerning pathologies compared with 1 in 10 before, waiting times have been cut from nine to five months, with more early vs late stage abnormal cell changes being detected.

“It’s great to have the support of NHS Scotland, and we are excited to continue working closely to see how the technology can help further improve access to early cancer detection for patients,” said Dr Marcel Gehrung, CEO and Co-founder at Cyted. “This is the first national roll-out of many and we are scaling globally to realise the full potential of patient impact for our technology.”

Under the roll-out, approximately 5,000 tests are expected to be delivered per year for the first two years, which will then be increased to 8,000 per year. Scaling up the number of tests deployed will allow more patients to be tested, helping identify a greater number of patients at risk of developing oesophageal cancer. There are around 9,300 new oesophageal cancer cases in the UK every year. The key to saving lives is to detect cancer at an earlier stage of Barrett’s oesophagus before it becomes cancerous.

“The development of the capsule sponge test has been a major breakthrough in improving early diagnosis of pre and early oesophageal cancer in Scotland. It has prioritised patients care where a rapid diagnosis is critical. We hope that ultimately this will lead to improved survival in this  high mortality cancer “- Professor Grant Fullarton, Clinical Lead CytoScot NHS Scotland spokesperson.