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Predictors of the experience of a Cytosponge test: analysis of patient survey data from the BEST3 trial

Lookup NU author(s): Emeritus Professor Greg RubinORCiD, Stephen Attwood



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023, The Author(s).Background: The Cytosponge is a cell-collection device, which, coupled with a test for trefoil factor 3 (TFF3), can be used to diagnose Barrett’s oesophagus, a precursor condition to oesophageal adenocarcinoma. BEST3, a large pragmatic, randomised, controlled trial, investigated whether offering the Cytosponge-TFF3 test would increase detection of Barrett’s. Overall, participants reported mostly positive experiences. This study reports the factors associated with the least positive experience. Methods: Patient experience was assessed using the Inventory to Assess Patient Satisfaction (IAPS), a 22-item questionnaire, completed 7–14 days after the Cytosponge test. Study cohort: All BEST3 participants who answered ≥ 15 items of the IAPS (N = 1458). Statistical analysis: A mean IAPS score between 1 and 5 (5 indicates most negative experience) was calculated for each individual. ‘Least positive’ experience was defined according to the 90th percentile. 167 (11.4%) individuals with a mean IAPS score of ≥ 2.32 were included in the ‘least positive’ category and compared with the rest of the cohort. Eleven patient characteristics and one procedure-specific factor were assessed as potential predictors of the least positive experience. Multivariable logistic regression analysis using backwards selection was conducted to identify factors independently associated with the least positive experience and with failed swallow at first attempt, one of the strongest predictors of least positive experience. Results: The majority of responders had a positive experience, with an overall median IAPS score of 1.7 (IQR 1.5–2.1). High (OR = 3.01, 95% CI 2.03–4.46, p < 0.001) or very high (OR = 4.56, 95% CI 2.71–7.66, p < 0.001) anxiety (relative to low/normal anxiety) and a failed swallow at the first attempt (OR = 3.37, 95% CI 2.14–5.30, p < 0.001) were highly significant predictors of the least positive patient experience in multivariable analyses. Additionally, sex (p = 0.036), height (p = 0.032), alcohol intake (p = 0.011) and education level (p = 0.036) were identified as statistically significant predictors. Conclusion: We have identified factors which predict patient experience. Identifying anxiety ahead of the procedure and discussing particular concerns with patients or giving them tips to help with swallowing the capsule might help improve their experience. Trial registration ISRCTN68382401.

Publication metadata

Author(s): Ghimire B, Landy R, Maroni R, Smith SG, Debiram-Beecham I, Sasieni PD, Fitzgerald RC, Rubin G, Walter FM, Waller J, Attwood S, Parmar M, Delaney B, de Caestecker J, Atkin W, Hackshaw A, van Heyningen C, Underwood T, Stella A, Saxby C, Lorincz A, Turnbull N, Doorbar J, Mannion-Krase G, Kaimi I, Kasanicki M, Kelleher S, Stockley L, Assari T, Kadyan S, Hollamby V, Edwards K, MacDonald H, Shaw V, Leishman H, Roper H, McCloskey K, Jung H, Phillips A, Masjak-Newman G, Fell K, Collins H, Zolle O, McGlone P, Crabb T, Merrin L, Cross M, Jones A, Simpson T, Murray E, Perugia A, Thompson M, Dumbleton J, Morar M, Frowd N, Hardcastle A, Carmichael D, Maxton F, Farnworth F, Baddeley E, Offman J

Publication type: Article

Publication status: Published

Journal: BMC Gastroenterology

Year: 2023

Volume: 23

Issue: 1

Online publication date: 10/01/2023

Acceptance date: 20/12/2022

Date deposited: 24/01/2023

ISSN (electronic): 1471-230X

Publisher: BioMed Central Ltd


DOI: 10.1186/s12876-022-02630-1

PubMed id: 36627580


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Funder referenceFunder name
C14478/A21047Cancer Research UK CRUK (open competition)
National Institute for Health Research
UK National Health Service