The management of eosinophilic esophagitis (EoE) in clinical practice compulsory requires repeated endoscopies with mucosal biopsies to assess disease activity. Less invasive and expensive means of monitoring of EoE is required and have been largely pursued.
Among these minimally invasive tests, the cytospounge represents a potential device. It is a small mesh sponge within a soluble gelatin capsule that can safely be administered orally by a nurse in primary care settings to collect esophageal cells for analysis. After having demonstrated some utility in assessing Barrett esophagus, a chronic condition with potential of maligancy, a first research with this device in patients with EoE has been also developed and published recently.
In this prospective cross-sectional study was carried out at two American hospitals (Mayo Clinic, Rochester Minnesota and University of North Carolina School of Medicine, Chapel Hill) with the objective of assessing the accuracy, safety, and tolerability of the cytosponge compared to endoscopy and biopsy for histologic assessment of EoE.
Adult patients with known EoE underwent cytosponge sampling followed by endoscopy and biopsy. Sample adequacy and eosinophil counts (expressed as eosinophils per high power field) were determined for both cytosponge and endoscopic samples. The cytosponge was assessed for diagnostic accuracy, safety, and patient preference as compared to endoscopy, which constitutes the gold standard.
80 patients who underwent to 150 procedures completed the study, and only six patients (7%) failed to swallow the sponge. The cytosponge samples were adequate in 102 procedures and the biopsy in 104; 101 procedures had adequate samples by both techniques.
Fifty-seven biopsies were graded as active EoE with ≥15 eos/HPF as the gold standard. Eosinophil counts highly correlated between the biopsy and cytosponge. Using a cutoff of ≤15 eos/HPF for inactive disease, the sensitivity of the cytosponge (this is, the probability of detection or the proportion of active EoE cases that were correctly identified as such) was 75%. This means that one out of 4 patients with active disease was not detected by the cytospounge.
The specificity of the cytosponge (or the percentage of inactive EoE patients who were correctly identified as not having active eosinophilic inflammation) was 86%. Therefore, the cytosponge identified as active disease 14% of patients who realy were into remission. For biopsies with inactive EoE, the cytosponge identified 38/44.
No complications occurred, and cytosponge endoscopic abrasion scores were low (0.34/4). Regarding tolerability, patients preferred cytosponge to endoscopy with higher rating scores (7.27 vs. 6.11).
The authors conclude that, compared to endoscopy with biopsy, cytosponge provided a minimally invasive, safe, well tolerated method. However, the accurate to assess EoE histologic activity was only moderate. Further studies are needed before incorporating this noved method to routine clinical practice, as well as developing new analystical strategis to improve the results of cytospounge in an EoE setting.
Read the full paper at: https://www.ncbi.nlm.nih.gov/pubmed/28809387