Oesophageal adenocarcinoma incidence is rising in the UK ^[1][2], yet no national screening programme exists. Current Barrett’s surveillance and reflux investigations rely on endoscopy, an invasive, carbon-heavy and resource-intensive procedure ^[3]. Capsule sponge testing offers a minimally invasive, nurse-led, and environmentally sustainable alternative that detects biomarkers such as TFF3 and p53 with high accuracy and better patient tolerance ^[4]. Despite ESGE guidance supporting these approaches, uptake remains limited. This review evaluated the implementation, diagnostic yield, and safety of capsule sponge testing at Milton Keynes University Hospital (MKUH). This review also considered the sustainability impact of capsule sponge testing in line with ESGE and BSG Green Endoscopy guidance promoting low-carbon diagnostic pathways ^[3][5].  

A retrospective service review was conducted at MKUH between January 2024 and July 2025. Patients meeting inclusion criteria underwent capsule sponge testing and were stratified into Barrett’s surveillance (n=45) and reflux case-finding (n=232) cohorts. Data collected included demographics, biomarker positivity (TFF3 for intestinal metaplasia [IM], squamous/columnar atypia, p53), and subsequent gastroscopy conversion. All procedures were nurse-led and delivered in a community diagnostic centre. Primary measures were the detection of dysplasia in the Barrett’s cohort and the detection of IM and/or dysplasia in the reflux cohort. Patients with abnormal biomarker or cytology results were referred for confirmatory gastroscopy. 

In the Barrett’s surveillance cohort (n=45), mean age was 64.6 years (71.1% male). Dysplasia was detected in 3 patients (6.7%).  6 (13.3%) had no IM on capsule testing despite prior diagnoses, prompting re-evaluation of previous endoscopies and removal from surveillance. 13 (28.9%) were referred for gastroscopy: 2 (4.4%) due to capsule intolerance and 11 (24.4%) for abnormal biomarkers, confirming dysplasia in 3 cases. Overall, 71.1% of Barrett’s patients avoided gastroscopy after capsule testing. 

In the reflux cohort (n=232), mean age was 68.9 years (37.2% males). IM was identified in 54 patients (23.3%), leading to 14 new Barrett’s diagnoses and 1 dysplasia. 2 had IM with gastric atrophy without Barrett’s. Overall, 86 patients (37.1%) were recommended for gastroscopy. 83/232 (35.8%) underwent the procedure: 62 (26.7%) for abnormal biomarkers and 21 (9.1%) for capsule intolerance or non-diagnostic procedures.  Three patients (1.3%) declined despite clinical recommendation. Consequently, 62.9% of patients avoided immediate gastroscopy following capsule testing. Adverse events were minimal and self-limiting: hypotension (n=1), transient hypertension (n=2), and tachycardia (n=1). No serious complications occurred. 

Capsule sponge testing proved feasible, safe and effective in both cohorts. In the Barrett’s cohort, dysplasia was detected in 3 patients. 6 prior Barrett’s diagnoses were reclassified as non-Barrett's, avoiding any further unnecessary gastroscopies. In the reflux cohort, IM was identified in 54 patients, resulting in 14 new diagnoses of Barrett's and 1 dysplasia, demonstrating its value for early detection. The procedure showed excellent patient tolerability with only minor transient adverse effects. These findings support ESGE guidance, advocating minimally invasive, nurse-led diagnostic approaches, establishing capsule sponge testing as a safe, scalable, and sustainable tool for risk stratification and early detection of oesophageal disease ^[4]. By reducing procedure demand, resource use and carbon output, capsule sponge testing represents a practical application of ESGE and BSG Green Endoscopy principles within routine diagnostic pathways ^[3][5].