20 YEARS IN GAST ROENT E ROLOGY
a need for a method to detect precancerous conditions of the stomach before endoscopy in selected cohorts – an idea that has proved to be cost effective in the US18
–
and it is likely that this approach will be widely adopted to alleviate the burden on secondary care resources and improve patient outcomes.
Oesophageal pathology There is also a drive to implement non- invasive point-of-care diagnostic tests for investigating oesophageal pathology. The Cytosponge (Medtronic) is a relatively new diagnostic test that consists of a small capsule on a string. Once swallowed, the capsule dissolves in the stomach to reveal a small brush, which collects cell samples from the oesophagus as it is retracted and enables molecular testing for markers of oesophageal diseases, such as BE, dysplasia and cancer.19
Research has shown
that this method can be combined with functional serology to investigate the upper gastrointestinal tract for adenocarcinoma prior to endoscopy, evaluating cells from the oesophagus and oesophago-gastric junction, and stomach biomarkers for a more comprehensive upper gastrointestinal assessment.17
Simple non-invasive diagnostic tests have also been developed for patients presenting with symptoms of reflux in non- gastroenterology settings such as Ear Nose and Throat (ENT), prior to laryngoscopy. Laryngopharyngeal reflux (LPR) does not cause typical gastroesophageal reflux symptoms, such as heartburn, but rather causes uncomfortable symptoms that are considered ‘extra-gastric’, including a chronic cough and sore throat.
The condition is usually investigated using
laryngoscopy to evaluate the appearance of the larynx, further contributing to the burden on specialist services. Instead, fast and reliable lateral flow technology can non-invasively detect pepsin in expectorated saliva, a key indicator of reflux in the upper airway. This simple test (Peptest, RDBiomed) takes minutes to complete, and does not require specialist equipment, significantly improving the speed of diagnosis and further simplifying the patient care pathway.
Summary
Gastroenterology has developed immensely over the last few decades, as we understand more about the impact of the gastrointestinal system on our health. However, this greater awareness of gastrointestinal diseases, combined with a relatively low threshold for referrals, has resulted in a greater burden on endoscopy services. It is clearly apparent that reducing the burden on endoscopy clinics is a key priority for the future of gastroenterology services. As a result,
recent advances in the field have focused on making endoscopy a faster and less complicated procedure, as well as finding ways to diagnose risk prior to referral. There is much discussion in the industry about the benefits of implementing non- invasive, case-selection methods to diagnose upper gastrointestinal conditions before endoscopy, drawing from a large evidence base and experience from other countries, and functional serology is presenting itself as a viable and realistic option. It is therefore important that we encourage the earlier, non- invasive detection of upper gastrointestinal diseases, in order to make this approach the standard in the near future and, ultimately, improve patient outcomes.
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2 Pincock, S. (2005). Nobel prize winners Robin Warren and Barry Marshall. The Lancet, 366(9495), 1429.
3 Kaunitz, J. D. (2014). The fruits of fiber: the invention of the flexible fiberoptic gastroscope. Digestive Diseases and Sciences, 59(11), 2616-2618.
4 Graham, D. G., & Banks, M. R. (2015). Advances in upper gastrointestinal endoscopy. F1000Research, 4.
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7 Wood, N. J. (2010). Guided capsule endoscopy appears feasible and accurate for exploration of the stomach. Nature Reviews Gastroenterology & Hepatology, 7(9), 473-473. https://doi. org/10.1038/nrgastro.2010.120
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GOV.UK. (2015). ‘Be Clear on Cancer’ campaign highlights links between heartburn and cancer. [online] Available at:
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12 NHS. (2017). Transforming gastroenterology elective NOVEMBER 2022
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