{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:44:52Z","timestamp":1793036692212,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T00:00:00Z","timestamp":1684800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NHS"},{"name":"NHS Scotland for the Implementation Pilots"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,12]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Coronavirus pandemic (COVID-19) curtailed endoscopy services, adding to diagnostic backlogs. Building on trial evidence for a non-endoscopic oesophageal cell collection device coupled with biomarkers (Cytosponge), an implementation pilot was launched for patients on waiting lists for reflux and Barrett\u2019s oesophagus surveillance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>(i) To review reflux referral patterns and Barrett\u2019s surveillance practices. (ii) To evaluate the range of Cytosponge findings and impact on endoscopy services.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and methods<\/jats:title>\n                  <jats:p>Cytosponge data from centralized laboratory processing (trefoil factor 3 (TFF3) for intestinal metaplasia (IM), haematoxylin &amp; eosin for cellular atypia and p53 for dysplasia) over a 2-year period were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 10\u200a577 procedures were performed in 61 hospitals in England and Scotland, of which 92.5% (N\u2009=\u20099784\/10\u200a577) were sufficient for analysis. In the reflux cohort (N\u2009=\u20094074 with gastro-oesophageal junction sampling), 14.7% had one or more positive biomarkers (TFF3: 13.6% (N\u2009=\u2009550\/4056), p53: 0.5% (21\/3974), atypia: 1.5% (N\u2009=\u200963\/4071)), requiring endoscopy. Among samples from individuals undergoing Barrett\u2019s surveillance (N\u2009=\u20095710 with sufficient gland groups), TFF3-positivity increased with segment length (odds ratio\u2009=\u20091.37 per cm (95% confidence interval: 1.33\u20131.41, P\u2009&amp;lt;\u20090.001)). Some surveillance referrals (21.5%, N\u2009=\u20091175\/5471) had \u22641\u2009cm segment length, of which 65.9% (707\/1073) were TFF3 negative. Of all surveillance procedures, 8.3% had dysplastic biomarkers (4.0% (N\u2009=\u2009225\/5630) for p53 and 7.6% (N\u2009=\u2009430\/5694) for atypia), increasing to 11.8% (N\u2009=\u2009420\/3552) in TFF3+ cases with confirmed IM and 19.7% (N\u2009=\u200958\/294) in ultra-long segments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Cytosponge-biomarker tests enabled targeting of endoscopy services to higher-risk individuals, whereas those with TFF3 negative ultra-short segments could be reconsidered regarding their Barrett\u2019s oesophagus status and surveillance requirements. Long-term follow-up will be important in these cohorts.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/qjmed\/hcad093","type":"journal-article","created":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:09:21Z","timestamp":1684886961000},"page":"659-666","source":"Crossref","is-referenced-by-count":15,"title":["Real-world implementation of non-endoscopic triage testing for Barrett\u2019s oesophagus during COVID-19"],"prefix":"10.1093","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4042-4820","authenticated-orcid":false,"given":"R","family":"Landy","sequence":"first","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health , Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Killcoyne","sequence":"additional","affiliation":[{"name":"Cyted Ltd , 22 Station Road , Cambridge CB1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Tang","sequence":"additional","affiliation":[{"name":"Cyted Ltd , 22 Station Road , Cambridge CB1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Juniat","sequence":"additional","affiliation":[{"name":"Cyted Ltd , 22 Station Road , Cambridge CB1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"O\u2019Donovan","sequence":"additional","affiliation":[{"name":"Cyted Ltd , 22 Station Road , Cambridge CB1 2JD, UK"},{"name":"Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Goel","sequence":"additional","affiliation":[{"name":"Cyted Ltd , 22 Station Road , Cambridge CB1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Gehrung","sequence":"additional","affiliation":[{"name":"Cyted Ltd , 22 Station Road , Cambridge CB1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R C","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Department of Oncology, Early Cancer Institute, University of Cambridge , Cambridge CB2 0XZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,23]]},"reference":[{"key":"2023091218072206100_hcad093-B1","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1016\/S1470-2045(22)00540-X","article-title":"European Groundshot\u2014addressing Europe\u2019s cancer research challenges: a Lancet Oncology Commission","volume":"24","author":"Lawler","year":"2023","journal-title":"Lancet Oncol"},{"key":"2023091218072206100_hcad093-B2","volume-title":"Life Sciences Industrial Strategy Update","author":"Bell","year":"2020"},{"key":"2023091218072206100_hcad093-B3","author":"NHS","year":"2019"},{"key":"2023091218072206100_hcad093-B4","doi-asserted-by":"crossref","first-page":"e653","DOI":"10.1016\/S1470-2045(17)30698-8","article-title":"Future cancer research priorities in the USA: a Lancet Oncology Commission","volume":"18","author":"Jaffee","year":"2017","journal-title":"Lancet Oncol"},{"key":"2023091218072206100_hcad093-B5","doi-asserted-by":"crossref","first-page":"eaay9040","DOI":"10.1126\/science.aay9040","article-title":"Early detection of cancer","volume":"375","author":"Crosby","year":"2022","journal-title":"Science"},{"key":"2023091218072206100_hcad093-B6","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1038\/s41591-022-01746-x","article-title":"The future of early cancer detection","volume":"28","author":"Fitzgerald","year":"2022","journal-title":"Nat Med"},{"key":"2023091218072206100_hcad093-B7","volume-title":"The Spread Challenge: How to Support the Successful Uptake of Innovations and Improvements in Health Care","author":"Horton","year":"2018"},{"key":"2023091218072206100_hcad093-B8","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1053\/gast.2002.30297","article-title":"Preoperative prevalence of Barrett\u2019s esophagus in esophageal adenocarcinoma: a systematic review","volume":"122","author":"Dulai","year":"2002","journal-title":"Gastroenterology"},{"key":"2023091218072206100_hcad093-B9","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1136\/gutjnl-2014-308865","article-title":"Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett\u2019s oesophagus","volume":"65","author":"El-Serag","year":"2016","journal-title":"Gut"},{"key":"2023091218072206100_hcad093-B10","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1111\/apt.13783","article-title":"Systematic review with meta-analysis: prevalent vs. incident oesophageal adenocarcinoma and high-grade dysplasia in Barrett\u2019s oesophagus","volume":"44","author":"Visrodia","year":"2016","journal-title":"Aliment Pharmacol Ther"},{"key":"2023091218072206100_hcad093-B11","author":"Cancer Research UK","year":"2020"},{"key":"2023091218072206100_hcad093-B12","doi-asserted-by":"crossref","first-page":"17048","DOI":"10.1038\/nrdp.2017.48","article-title":"Oesophageal cancer","volume":"3","author":"Smyth","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"2023091218072206100_hcad093-B13","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1136\/gut.2004.051821","article-title":"Epidemiology of gastro-oesophageal reflux disease: a systematic review","volume":"54","author":"Dent","year":"2005","journal-title":"Gut"},{"key":"2023091218072206100_hcad093-B14","doi-asserted-by":"crossref","first-page":"5814","DOI":"10.1038\/s41598-020-62795-1","article-title":"Global prevalence and risk factors of gastro-oesophageal reflux disease (GORD): systematic review with meta-analysis","volume":"10","author":"Nirwan","year":"2020","journal-title":"Sci Rep"},{"key":"2023091218072206100_hcad093-B15","first-page":"e31","article-title":"Magnitude and time-trend analysis of postendoscopy esophageal adenocarcinoma: a systematic review and meta-analysis","volume":"160","author":"Sawas","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2023091218072206100_hcad093-B16","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1053\/j.gastro.2021.12.270","article-title":"Clinical and endoscopic characteristics associated with post-endoscopy upper gastrointestinal cancers: a systematic review and meta-analysis","volume":"162","author":"Alexandre","year":"2022","journal-title":"Gastroenterology"},{"key":"2023091218072206100_hcad093-B17","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1136\/gutjnl-2019-318985","article-title":"Histopathologist features predictive of diagnostic concordance at expert level among a large international sample of pathologists diagnosing Barrett\u2019s dysplasia using digital pathology","volume":"69","author":"van der Wel","year":"2020","journal-title":"Gut"},{"key":"2023091218072206100_hcad093-B18","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1053\/j.gastro.2016.10.041","article-title":"Discordance among pathologists in the United States and Europe in diagnosis of low-grade dysplasia for patients with Barrett's esophagus","volume":"152","author":"Vennalaganti","year":"2017","journal-title":"Gastroenterology"},{"key":"2023091218072206100_hcad093-B19","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1136\/jclinpath-2020-206511","article-title":"Performance of gastrointestinal pathologists within a national digital review panel for Barrett\u2019s oesophagus in the Netherlands: results of 80 prospective biopsy reviews","volume":"74","author":"Klaver","year":"2021","journal-title":"J Clin Pathol"},{"key":"2023091218072206100_hcad093-B20","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/S0046-8177(88)80344-7","article-title":"Observer variation in the diagnosis of dysplasia in Barrett\u2019s esophagus","volume":"19","author":"Reid","year":"1988","journal-title":"Hum Pathol"},{"key":"2023091218072206100_hcad093-B21","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.cgh.2018.08.066","article-title":"Low prevalence of suspected Barrett\u2019s esophagus in patients with gastroesophageal reflux disease without alarm symptoms","volume":"17","author":"Lin","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2023091218072206100_hcad093-B22","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/S1470-2045(21)00667-7","article-title":"Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett\u2019s oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot","volume":"23","author":"Pilonis","year":"2022","journal-title":"Lancet Oncol"},{"key":"2023091218072206100_hcad093-B23","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S2468-1253(16)30118-2","article-title":"Risk stratification of Barrett\u2019s oesophagus using a non-endoscopic sampling method coupled with a biomarker panel: a cohort study","volume":"2","author":"Ross-Innes","year":"2017","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2023091218072206100_hcad093-B24","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S0140-6736(20)31099-0","article-title":"Cytosponge-trefoil factor 3 versus usual care to identify Barrett\u2019s oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial","volume":"396","author":"Fitzgerald","year":"2020","journal-title":"Lancet"},{"key":"2023091218072206100_hcad093-B25","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/dc.24354","article-title":"Role of TFF3 as an adjunct in the diagnosis of Barrett\u2019s esophagus using a minimally invasive esophageal sampling device\u2014the Cytosponge\u2122","volume":"48","author":"Paterson","year":"2020","journal-title":"Diagn Cytopathol"},{"key":"2023091218072206100_hcad093-B26","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1016\/j.cgh.2021.07.047","article-title":"Cytosponge-TFF3 testing can detect precancerous mucosal changes of the stomach","volume":"20","author":"Hadjinicolaou","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2023091218072206100_hcad093-B27","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.mpdhp.2015.04.001","article-title":"p53 Immunohistochemistry as a biomarker of dysplasia and neoplastic progression in Barrett\u2019s oesophagus","volume":"21","author":"Kaye","year":"2015","journal-title":"Diagn Histopathol"},{"key":"2023091218072206100_hcad093-B28","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1136\/gutjnl-2013-305372","article-title":"British Society of Gastroenterology guidelines on the diagnosis and management of Barrett\u2019s oesophagus","volume":"63","author":"Fitzgerald","year":"2014","journal-title":"Gut"},{"key":"2023091218072206100_hcad093-B29","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2022"},{"key":"2023091218072206100_hcad093-B30","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.cgh.2017.11.044","article-title":"Factors associated with progression of Barrett\u2019s esophagus: a systematic review and meta-analysis","volume":"16","author":"Krishnamoorthi","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2023091218072206100_hcad093-B31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12875-016-0440-0","article-title":"The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study","volume":"17","author":"Thompson","year":"2016","journal-title":"BMC Fam Pract"},{"key":"2023091218072206100_hcad093-B32","author":"Prime","year":"2022"},{"key":"2023091218072206100_hcad093-B33","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1136\/gutjnl-2011-300730","article-title":"The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett\u2019s oesophagus: a meta-analysis","volume":"61","author":"Desai","year":"2012","journal-title":"Gut"},{"key":"2023091218072206100_hcad093-B34","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.cgh.2009.10.010","article-title":"Risk of esophageal adenocarcinoma and mortality in patients with Barrett\u2019s esophagus: a systematic review and meta-analysis","volume":"8","author":"Sikkema","year":"2010","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2023091218072206100_hcad093-B35","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1056\/NEJMoa1103042","article-title":"Incidence of adenocarcinoma among patients with Barrett\u2019s esophagus","volume":"365","author":"Hvid-Jensen","year":"2011","journal-title":"N Engl J Med"},{"key":"2023091218072206100_hcad093-B36","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1136\/gut.2009.176701","article-title":"Risk of malignant progression in patients with Barrett\u2019s oesophagus: a Dutch nationwide cohort study","volume":"59","author":"de Jonge","year":"2010","journal-title":"Gut"},{"key":"2023091218072206100_hcad093-B37","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.cgh.2018.08.033","article-title":"Incidence of progression of persistent nondysplastic Barrett\u2019s esophagus to malignancy","volume":"17","author":"Peters","year":"2019","journal-title":"Clin Gastroenterol Hepatol"}],"container-title":["QJM: An International Journal of Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/qjmed\/advance-article-pdf\/doi\/10.1093\/qjmed\/hcad093\/50693746\/hcad093.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/qjmed\/article-pdf\/116\/8\/659\/51534424\/hcad093.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/qjmed\/article-pdf\/116\/8\/659\/51534424\/hcad093.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T18:07:49Z","timestamp":1694542069000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/qjmed\/article\/116\/8\/659\/7176377"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,23]]},"references-count":37,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,5,23]]},"published-print":{"date-parts":[[2023,9,12]]}},"URL":"https:\/\/doi.org\/10.1093\/qjmed\/hcad093","relation":{},"ISSN":["1460-2725","1460-2393"],"issn-type":[{"value":"1460-2725","type":"print"},{"value":"1460-2393","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,8,1]]},"published":{"date-parts":[[2023,5,23]]}}}