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Introduction Oesophageal adenocarcinoma incidence is rising in the UK. 1 2 Capsule sponge testing offers a minimally invasive, nurse-led, and sustainable alternative to endoscopic Barrett’s surveillance, aligned with BSG Green Endoscopy guidance.4 This review evaluated the implementation, diagnostic yield, and safety of capsule sponge testing within an NHS service.Methods A retrospective service review was conducted at Milton Keynes University Hospital 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. Primary measures were detection of dysplasia in the Barrett’s cohort and detection of IM and/or dysplasia in the reflux cohort. Patients with abnormal biomarker or cytology results were referred for confirmatory gastroscopy.Results In the Barrett’s surveillance cohort (n=45; mean age 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 and removal from surveillance. 13 (28.9%) were referred for gastroscopy, resulting in 71.1% avoiding gastroscopy after capsule testing.In the reflux cohort (n=232; mean age 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, with 83 (35.8%) undergoing the procedure. 3 patients (1.3%) declined despite clinical recommendation. Consequently, 62.9% 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.Conclusions Capsule sponge testing was safe and effective in both cohorts. In the Barrett’s cohort, dysplasia was detected in 3 patients. 6 prior diagnoses were reclassified as non-Barrett’s, avoiding unnecessary gastroscopies. In the reflux cohort, IM was identified in 54 patients, resulting in 14 new Barrett’s and 1 dysplasia diagnoses, supporting early detection. Patient tolerability was excellent with only minor transient adverse effects. These findings support BSG guidance, establishing capsule sponge testing as a scalable and sustainable nurse-led tool for risk stratification and early oesophageal disease detection. 3 By reducing procedure demand, resource use and carbon output, capsule sponge testing represents a practical application of BSG Green Endoscopy principles within routine NHS diagnostic pathways.4References Lin Y, Wang H, Fang K, Zheng Y, Wu J. International trends in esophageal cancer incidence rates by histological subtype (1990–2012) and prediction of the rates to 2030. Esophagus. 2022 Jun 11;19(4):560–8. doi: 10.1007/s10388-022-00927-4Chimba C, Bannister P, Memon A. Changing epidemiology and trends in incidence of oesophageal cancer in England, 1985-2017. European Journal of Public Health 2021 Oct 20;31(3). doi:10.1093/eurpub/ckab165.230Rodríguez de Santiago E, Dinis-Ribeiro M, Pohl H, Agrawal D, Arvanitakis M, Baddeley R, et al. Reducing the environmental footprint of gastrointestinal endoscopy: European society of gastrointestinal endoscopy (ESGE) and European society of gastroenterology and endoscopy nurses and associates (ESGENA) position statement. Endoscopy 2022 Jul 8;54(08):797–826. doi:10.1055/a-1859-3726Sebastian S, Dhar A, Baddeley R, Donnelly L, Haddock R, Arasaradnam R, et al. Green endoscopy: British society of gastroenterology (BSG), joint accreditation group (JAG) and centre for sustainable health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023 Jan;72(1):12–26. doi:10.1136/gutjnl-2022-328460