How can endoscopy units free up capacity after FIT changes?

Managing endoscopy demand with capsule sponge testing in the face of FIT criteria change

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The faecal immunochemical test (FIT) is the foundation of the NHS Bowel Cancer Screening Programme, which invites people aged between 50 and 74 to take part in home testing every two years. Patients with abnormal results – traces of blood above a certain threshold – are then offered further investigation, often including a colonoscopy. In early 2026, the threshold for referral was lowered, which is predicted to significantly increase the number of colonoscopies performed every year. While this is good news for detecting bowel cancer, the resulting rise in colonoscopies will add to the already busy workloads of endoscopy departments. This threatens to upset the delicate balance of assigning resources – including shared staff and spaces – equitably across all procedures. For this reason, clinicians and endoscopists from both the lower and upper gastrointestinal specialties are actively exploring alternative approaches – such as capsule sponge testing for reflux and Barrett’s oesophagus investigations – that can reduce the overall burden on services, freeing up capacity for the impending increase in colonoscopies.

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How capsule sponge testing can reduce endoscopy demand

One situation where capacity gains could be made is by changing the surveillance programmes for patients with Barrett’s oesophagus, a condition linked to a significant increase in the chance of developing oesophageal adenocarcinoma. These patients are typically monitored by endoscopy every two to five years, depending on the maximal length of the Barrett’s segment and other clinical risk factors. However, these endoscopies are also typically low yield; the overall annual incidence of oesophageal adenocarcinoma in Barrett’s patients is approximately 0.3 per cent.^7,8 Annual risk of progression increases to 10-30 per cent if a patient develops dysplasia.⁷ Despite the low incidence, people with Barrett’s oesophagus are 11 times more likely to develop oesophageal adenocarcinoma than the general population.⁹ However, evidence has not shown that the current model of endoscopic surveillance improves clinical outcomes.¹⁰ The challenge is therefore to provide sufficient oversight to detect dysplastic progression and early cancer, while avoiding a high surveillance burden for a population in which absolute progression risk remains low.

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The EndoSign^® capsule sponge test, developed by Cyted Health, offers a minimally invasive way to check for changes associated with dysplasia and cancer without requiring endoscopy. Patients swallow a ‘pill-on-a-thread’ that dissolves in the stomach to release a sponge, which is then gently withdrawn, collecting cells from the entire oesophagus that are then tested at a central laboratory for relevant biomarkers. The results can be used to identify patients who require further assessment using endoscopy.

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A recent multi-centre study found that switching to capsule sponge-based triage released endoscopy staff, space and resources for trusts to perform more colonoscopies. Low risk patients can be safely discharged, while those identified as high risk are quickly referred into endoscopy pathways. Overall, capsule sponge testing can free up to 38.02 days of endoscopy capacity, which significantly reduces waiting lists.¹¹

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Improving patient flow without compromising outcomes

Capsule sponge pathways enable risk stratification for more effective surveillance of Barrett’s oesophagus, ensuring that the limited endoscopic resources are prioritised for patients at the highest risk of progression. EndoSign is already used at over 70 sites throughout the UK, allowing endoscopy services to identify individuals at the highest risk of developing dysplasia and cancer. Studies have shown that EndoSign helps to risk stratify patients; the test identifies around 54 per cent of Barrett’s oesophagus patients as low risk, with the risk of high grade dysplasia or cancer in this group being 0.4 per cent.¹² These figures led the authors to propose that it is likely possible to safely monitor these groups using either capsule sponge alone, or an alternating combination of capsule sponge and gastroscopy, depending on specific risk factors. 

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Capsule sponge technology could also benefit other pathways, such as reflux triage. Patients with routine reflux that does not respond to empirical treatment are typically referred for endoscopy to rule out Barrett’s oesophagus and other serious conditions, including cancer. Decreasing upper gastrointestinal endoscopies for reflux triage has the potential to free up a significant number of slots for colonoscopies, while still ensuring care gets to patients who need it most.

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Capsule sponge pathways also have several other advantages alongside improving the efficiency of endoscopy departments. Unlike gastroscopy, the procedure does not require sedation and can be carried out by any trained healthcare professional, offering a development opportunity for all staff. The test is also well tolerated and often preferred by patients, and the overall patient journey is more streamlined, with shorter appointments that can be carried out in any office setting, potentially enabling care to be delivered closer to home and avoiding stressful hospital trips. 

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Ensuring sustainable endoscopy capacity into the future

Demand on endoscopy services is only set to increase in the future, demonstrating the need to adopt innovative new solutions where possible, so that access to limited services can be managed effectively. EndoSign ensures that endoscopy is reserved for patients it would most benefit, optimises the available workforce and improves the patient experience. With the increased demand on endoscopy services from the more sensitive FIT threshold looming, capsule sponge testing offers an opportunity to build resilience into the system, and support endoscopy departments well into the future.

References

1. NHS England (2025). NHS rolls out lifesaving home testing for bowel cancer to over 50s. Available at: https://www.england.nhs.uk/2025/01/nhs-rolls-out-lifesaving-home-testing-for-bowel-cancer-to-over-50s/
2. Department of Health & Social Care (2026). The National Cancer Plan for England: delivering world class cancer care. Available at: https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version 
3. NHS England (2025). NHS to detect and prevent thousands more bowel cancers with more sensitive screening. Available at: https://www.england.nhs.uk/2026/01/nhs-detect-prevent-thousands-more-bowel-cancers-more-sensitive-screening/ 
4. NHS England. (2020). Diagnostics: Recovery and Renewal – Report of the Independent Review of Diagnostic Services for NHS England. https://www.england.nhs.uk/publication/diagnostics-recovery-and-renewal-report-of-the-independent-review-of-diagnostic-services-for-nhs-england/
5. Nieto, H., Lee, J., Hall, C., and McDermott, A. L. (2024). The Otolaryngology Consultant Workforce in England: A Survey Update and Future Repercussions. Clinical Otolaryngology, 49(5), 682-686
6. Januszewicz W, Fitzgerald RC. (2019). Barrett's oesophagus and oesophageal adenocarcinoma. Medicine (Abingdon). 47(5):275-285. doi:10.1016/j.mpmed.2019.02.005
7. Lorraine-Francis H, Newberry E, Aziz I (2023). Diagnostic yield of upper gastrointestinal endoscopy in patients attending a UK centre with symptoms compatible with Rome IV functional dyspepsia Frontline Gastroenterology 14:306-311.
8. Desai TK, Krishnan K, Samala N, et al. (2012). The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis. Gut. 61(7):970-976. doi:10.1136/gutjnl-2011-300730 
9. Hvid-Jensen F, Pedersen L, Drewes AM, et al. (2011). Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011;365:1375-1383. doi: 10.1056/NEJMoa1103042
10. Old O, Jankowski J, Attwood S, et al. (2025). Barrett’s Oesophagus Surveillance Versus Endoscopy at Need Study (BOSS): A Randomized Controlled Trial. Gastroenterology, 169, 1233-1243.e8
11. Vargas-Palacios A, Spencer K, Fayad R, et al. Assessing the impact of capsule sponge integration on NHS endoscopy capacity: A discrete event simulation study (2026). BSG Live. Available at: https://api.ltb.io/show/ACQQB
12. Tan, W K, Askinyte, V, et al. (2025). Biomarker risk stratification with capsule sponge in the surveillance of Barrett’s oesophagus: prospective evaluation of UK real-world implementation. The Lancet. 406(10500): 271-282

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