Introduction

Due to pandemic restrictions we established a new early diagnosis service for patients with reflux symptoms and those on our existing Barrett’s surveillance programme using Cytosponge as initial investigation in 2020. As this was the first time Cytosponge had been used in routine clinical practice in this setting it was important to involve patients in the evaluation of the service.

Aims & Methods

The service was established in a district general hospital with catchment area 600,000. All patients who had a Cytosponge procedure between 01/05/2021 and 04/04/2023 were asked to complete a one-page survey about their experience on the same day as the procedure, prior to leaving the hospital. The survey contained demographic data and questions regarding their degree of discomfort using a visual analogue scale as well as whether they had had a previous endoscopy, and which one they preferred, if they thought the test was acceptable and whether they would be willing to have a Cytosponge again. There was also space for free text comments.

Results

829 patients completed the survey at least partially. No patients declined to participate. 393 (49.5%) were female, 401 Male(50.5%) 93% described themselves as white ethnicity 3.4% as Asian/Asian British, 1.2% as Black or Black British,2.2% as Mixed/other.
99.5% found the information leaflet helpful. Only 20/816 (2.5%) respondents felt that Cytosponge was an unacceptable test. 15% described no discomfort, 77% mild or minimal discomfort, 3% moderate discomfort, 5% severe/significant discomfort. 778 patients (94%) would be willing to have a Cytosponge again.
445/819 (54%) reported having a previous gastroscopy.329/383 (86%)reporting a preference preferred Cytosponge to gastroscopy.

Conclusion

These results support previous data from the BEST studies, and are the largest single site dataset showing the excellent acceptability of Cytosponge in the real-world setting. The evidence from patients for their preference for Cytosponge over gastroscopy will also give support for its use as in Barrett’s surveillance programmes going forward where multiple gastroscopies were previously required.

Introduction

Despite significant advances in the management of non-variceal upper gastrointestinal bleeding (NVUGIB), the optimal timing of endoscopy remains a subject of debate. Current guidelines recommend performing endoscopy within 24 hours of presentation, yet the impact of this strategy in different risk stratifications is not fully elucidated.
This study aimed to evaluate the influence of early endoscopy (≤24 hours) on clinical outcomes in NVUGIB patients, with particular focus on risk stratification using the Glasgow-Blatchford Score (GBS).

Aims & Methods

This retrospective, single-center cohort study included consecutive adult patients who underwent upper gastrointestinal endoscopy for suspected NVUGIB over a four-year period. Demographic, clinical, biochemical, endoscopic, and outcome data were collected and analyzed.
Patients were stratified based on GBS into low-risk (GBS <12) and high-risk (GBS ≥12) categories. The primary outcome was 30-day mortality. Secondary outcomes included need for endoscopic hemostasis and blood transfusion

Results

A total of 298 patients were included (mean age: 65.3 ± 17.1 years; 57% male), of whom 55% were classified as high-risk. Endoscopy was performed within 24 hours in 62.1% of cases.
In low-risk patients, early endoscopy was significantly associated with:

• Higher rate of endoscopic therapy (p = 0.003)
• Lower 30-day mortality (p = 0.03)
• Reduced need for blood transfusion (p = 0.03)

Patients in the low-risk group who underwent delayed endoscopy (>24 hours) were significantly older (70.8 ± 15.2 vs. 63.5 ± 16.7; p = 0.01), had more comorbidities (Charlson Comorbidity Index: 4.0 ± 2.1 vs. 3.1 ± 2.5; p = 0.02), lower baseline hemoglobin (10.1 ± 3.1 vs. 11.3 ± 2.8; p = 0.03), and were more frequently admitted during weekends or holidays (27 vs. 0; p < 0.001).
In contrast, in high-risk patients, no statistically significant differences in outcomes were observed between early and delayed endoscopy.

Conclusion

Our findings suggest that performing upper endoscopy within 24 hours is associated with improved clinical outcomes, specifically reduced mortality and transfusion requirements, in low-risk NVUGIB patients. Early intervention appears especially beneficial in older patients with multiple comorbidities and initial anemia. These data support prioritizing early endoscopic evaluation in selected lower-risk patients as part of optimized UGIB management pathways.

References

 Sung JJY, Chiu PWY, Chan FKL, Lau JYW, Goh KL, Ho LH, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding. Gut. 2018;67(10):1757–68.
 Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations. Ann Intern Med. 2019;171(11):805–22.
 Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip HC, Chan SM, et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med. 2020;382(14):1299–308.

Introduction

With the need to reduce the burden of endoscopy, capsule sponge enables cost effective and efficient triage for patients with reflux as shown in the National Health Service England (NHSE) pilot study whilst achieving a smaller carbon footprint in comparison to gastroscopy. Negative sponge follow up has yet to be reported. Using the largest single UK site database, we describe 1, 2 and 3 year follow up and quantify the effect of gastroscopy avoidance on the endoscopic carbon footprint.

Aims & Methods

Patients routinely referred between November 2020 and November 2023 to gastroscopy or gastroenterology clinic with reflux were selected as part of the DELTA or NHSE pilot studies and triaged to a new nurse led early diagnosis teleclinic where they were first offered a capsule sponge. Patients with positive tests, (Trefoil factor 3 TFF3 and/or atypia/p53 positivity indicating possible Barrett’s/gastric intestinal metaplasia or dysplasia respectively) all underwent mandatory gastroscopy and were excluded from this analysis. In the event of a negative test, nurse led teleclinic follow up occurred by 3 months and gastroscopy was only requested for ongoing/concerning symptoms. The endoscopy database for patients with a negative capsule sponge was reviewed at 1, 2 and 3 year intervals to review if gastroscopy had occurred and what findings were identified.

Results

At the 1, 2 and 3 year follow up intervals, 429 and 204 and 41 patients were identified respectively. 86% of the 1 year follow ups (n=371) had not represented for a gastroscopy. The most frequent findings in the 14% (n=57) who did undergo gastroscopy were gastritis (n=14), hiatus hernia (n=9) and normal (n=16). The most significant finding in this cohort was one case of gastric cancer, identified two weeks post capsule due to new concerning symptoms. In total 371 gastroscopies were avoided in year 1, equating to 42294L of water and 1846 kgeCO2. Of the 204 2 year follow up group, 92% (n=187) had not had a gastroscopy. There was no significant pathology (including Barrett’s) identified in any of the remaining 8% (n=17) and the most common endoscopic conclusion in this cohort was normal. Only 2/17 patients underwent their gastroscopy in the second year of follow up. Finally, of the 41 patients with a negative capsule sponge available to review at 3 year follow up, 21% (n=9) had undergone a gastroscopy however only 3 of these had been performed in year 3 and they were all normal. Importantly, no patient who represented for OGD at any of the intervals after a negative capsule sponge were found to have Barretts.

Conclusion

Over 1, 2 and 3 year follow up periods, our study provides reassuring data from the largest UK capsule sponge site. Our data shows that capsule sponge safely excluded significant upper GI pathology in a less invasive manner, enabling symptomatic management without necessitating gastroscopy in the majority of patients. Nurse led teleclinic safety netting proved effective in identifying patients needing additional investigations whilst reducing the number of gastroscopies performed. This has helped improve endoscopy access overall, whilst also tackling the growing concern surrounding the endoscopic carbon footprint. Our study supports a new paradigm for the investigation of reflux symptoms which can be incorporated in both community and secondary care pathways.

References

Greenhouse gas reporting: conversion factors 2022. GOV.UK. Published
September 20, 2022. Accessed January 26,
2023. https://www.gov.uk/government/publications/greenhouse-gas-reporting-

Disclosure

None

Introduction

Behaviours such as supra-gastric belching, gastric belching, and aerophagia, often identified during oesophageal physiology studies (e.g., 24-hour pH and impedance study), are known to exacerbate symptoms like reflux, bloating, and regurgitation. These behaviours are frequently misunderstood and may lead to unnecessary referrals to specialists or invasive interventions. Upper GI biofeedback (UGI BFB) therapy offers a tailored, non-invasive approach to help patients manage these behaviours. By teaching specific techniques such as diaphragmatic breathing, open-mouth posture, and the multiple rapid swallow technique, patients are empowered to take control of their symptoms, improve their quality of life, and reduce reliance on surgical or gastroenterology pathways.

Aims & Methods

• Participants: Between December 2022 and December 2024, 35 patients were referred for UGI BFB therapy. Most referrals (n=31) came after oesophageal physiology studies, with additional referrals from gastroenterologists for belching and bloating (n=2) and from clinical endoscopists for persistent hiccups and audible wheezing (n=2).
• Intervention: Patients attended a one-hour education session in the Gastrointestinal (GI) Physiology unit. This included a review of diagnostic findings and practical training in diaphragmatic breathing, open-mouth posture, and the multiple rapid swallow technique. A follow-up telephone consultation at 6–8 weeks allowed for monitoring progress. For cases of poor oesophageal clearance, referring clinicians were advised to consider prokinetics. For frequent gastric belching, small intestinal bacterial overgrowth (SIBO) breath testing was recommended to assess any additional contributing factors.

Results

• Supra-gastric belching episodes were reduced by 50% (mean: 24 episodes pre-therapy to 12 post-therapy; p<0.001).
• GERD-HRQL scores improved by 45%, indicating significant quality-of-life improvements (mean: 22 pre-therapy to 12 post-therapy; p<0.001).
• 75% of patients reported substantial reductions in belching, bloating, and reflux-like symptoms.
• Half of the patients (50%) no longer required specialist referrals, as symptoms were successfully managed with therapy or GP-led interventions, including prokinetics or medications for hypersensitivity.
• Stress emerged as a critical factor for most patients. Relaxation techniques, mindfulness, and stress management strategies played an important role in symptom control. One patient, who became a mental health first aider at work, reported long-term symptom relief due to stress reduction efforts.

Conclusion

Upper GI biofeedback therapy is a valuable approach for addressing behavioural contributors to symptoms like air swallowing, belching, and bloating. A multidisciplinary approach, involving cognitive behavioural therapy or hypnotherapy alongside UGI BFB, can be highly beneficial. The GI Physiology team also recognises its limitations and has found that referrals to Speech and Language Therapy can be instrumental when patients are unable to engage fully with the therapy. This collaborative, patient-centred approach ensures that UGI BFB therapy not only reduces the need for invasive procedures and specialist consultations but also empowers patients to adopt long-lasting lifestyle and behavioural changes.

Introduction

Upper gastrointestinal bleeding (UGIB) continues to pose a significant threat to patients presenting at the emergency department, especially if the patients present with hemodynamic instability. There are still some uncertainties in the guidelines about the stepwise assessment and management for those patients before undergoing endoscopy.

Aims & Methods

Our study aims to report practice patterns to better understand the pre-endoscopic assessment for patients presenting with acute UGIB. This is an international online survey that included a prospective two-phase data collection. The distribution was conducted from April 2023 to November 2023. The target population was active physicians with clinical practices focusing on the management of patients with UGIB. Study data were collected and managed using Research Electronic Data Capture (REDCap), an electronic data collection tool. The survey included four main sections (demographics and clinical practice, definition of hemodynamic instability, pre-endoscopy assessment, and optimal time for endoscopy) with a total of 33 relevant questions. The survey was endorsed by several national and international gastroenterology societies. The primary analysis was a descriptive assessment of individual survey response items in different domains. Descriptive statistics were reported as proportions. Secondary analysis evaluated differences in survey responses according to the years of clinical experience, type of practice location, and the estimated number of UGIB patients presented annually.

Results

In total, 533 clinicians completed our survey from 50 countries. Over half of the respondents work at university-based hospitals (54.6%) and have over 100 UGIB patients hospitalized annually (67.7%). In terms of clinical experience, 55.7% reported less than 10 years and 44.3% with more than 10 years. In 29.1% of the hospitals, there was no specific protocol or guideline for the initial assessment of patients with suspected UGIB, and in 44.7%, there were no emergency on-call interventional radiology services for such cases. Among the respondents, 39.6% do not use any risk stratification scores at the time of patient presentation. Both 0.9% saline (40.9%) and balanced crystalloid fluid (39.5%) were almost equally chosen as initial fluid resuscitation. However, the rate of fluid resuscitation was dependent on the hemodynamic status of 40.2% of the answers. In 40.7% of the answers, clinicians do not use any major hemorrhagic protocol for patients with severe ongoing bleeding and at risk of exsanguination. Prokinetics were generally little or never used prior to endoscopy in patients with UGIB (34.3%) or even in those with known gastric emptying problems (27.6%). The most chosen optimal time for endoscopy was within 24 hours for stable patients with non-variceal bleeding and within 12 hours for variceal bleeding. If patients were unstable but responding to resuscitation, the most chosen time was within 6 hours regardless of the source of bleeding and within 2 hours for those with persistent hemodynamic instability.

Conclusion

Adherence to international gastroenterology guidelines is low. There is a significant variability in different assessment approaches among respondents. Based on our data, the optimal time for endoscopy seems to be dependent on the hemodynamic status of patients with acute UGIB in both variceal and non-variceal bleeding. Our study highlights opportunities for improving consistency in reporting data and identifies potential areas for research.

Introduction

This study aims to assess the impact of antithrombotic therapy on endoscopic findings in patients hospitalized for upper gastrointestinal bleeding.

Aims & Methods

We carried out a prospective, single-center cross-sectional study including 332 patients between June 2020 and February 2025. Patients were classified as antithrombotic (AT) users if they were receiving antiplatelet agents (such as low-dose aspirin or thienopyridines) and/or anticoagulants (including vitamin K antagonists, direct oral anticoagulants, or heparin).

Results

The mean age of the study population was 59 ± 16.7 years, with a marked male predominance (77.1%). Among them, 63 patients (19%) were receiving antithrombotic (AT) therapy—41 on antiplatelet agents and 39 on anticoagulants. Patients in the AT group were significantly older (68 vs. 57 years; p < 0.001) and had a higher burden of comorbidities (75.8% vs. 16.7%; p < 0.001). However, there were no significant differences between the AT and non-AT groups regarding the presence of active bleeding at endoscopy (12.7% vs. 16.8%; p = 0.425) or the need for endoscopic hemostasis (7.9% vs. 16%; p = 0.1).
In multivariate analysis, after adjustment for age, sex, comorbidities, active bleeding, and AT use, only the presence of active bleeding was independently associated with the need for endoscopic hemostasis. Specifically, active bleeding at endoscopy increased the odds of requiring hemostasis by 26-fold (OR: 26, 95% CI: 12.9–62.15; p < 0.001), whereas AT therapy was not an independent predictor (OR: 0.386, 95% CI: 0.105–1.42; p = 0.154).

Conclusion

In older patients receiving antithrombotic therapy and admitted for upper gastrointestinal bleeding, the risk of active bleeding during endoscopy and the need for endoscopic hemostasis do not appear to be increased.