Having a capsule sponge test at Finchley Memorial Hospital

What is capsule sponge?

Problems with heartburn and acid reflux are common, although occasionally it can lead to changes in the normal cells that line your oesophagus (food pipe). On rare occasions these cells can develop into abnormal cells. This may lead to oesophageal (food pipe) cancer. When changes to cells are found early it can make any treatment simpler and the impact on a patient is less significant.

Capsule sponge is being offered to help identify patients who may require further investigations, such as endoscopy (a test with a camera to examine your food pipe and stomach). A capsule sponge test can also help your doctor investigate, manage and review your symptoms if it’s related to your acid reflux symptoms.

How is a capsule sponge procedure done?

This procedure involves a small capsule on a string, similar size to a vitamin tablet and is made from vegan gelatine. After it is swallowed, the capsule dissolves into a small sponge which is designed to collect a sample of cells from your oesophagus (food pipe) when pulled out of the stomach using the attached string. This will then be tested to find out if there are any cells which are unexpected or abnormal.

Before your procedure

You should keep taking all your usual medications. Please inform the booking team if you have diabetes and if you take any blood thinners (anticoagulant or antiplatelet medication) and/or diabetes medication. You will be contacted by the specialist nurse if you require tailored advice about your medication prior to procedure as fasting is required.

The day of your procedure
Please do not have anything to eat for at least six hours before your appointment time. You can drink small sips of water up to two hours before your appointment. Take your medication as normal, unless advised otherwise by a member of the team. Please bring a list of your medications with you to your appointment.

Remember to read and bring your consent form unsigned. Please arrive on time for your appointment so that we can manage the number of patients in the clinic. Your appointment will last around 30 minutes. If you have any questions when you arrive, please ask your nurse when you are admitted.

During the test

1. You will be collected from the waiting room by one of the nursing team who will take you to the clinic area.
2. You will be asked some questions to check that you are ready for your test and make sure you are comfortable.
3. The nurse will confirm your consent to the procedure, and you will be asked to sign your consent form.
4. The nurse uses an applicator to place the capsule on the back of the tongue. You will be given water to drink and asked to swallow the capsule.
5. You will swallow the capsule sponge and string. It will take around 7 minutes for the capsule to dissolve and the sponge will expand.
6. You will be given the option to have a local anesthetic spray (Lidocaine) into your throat. This will numb the area before the sponge is removed. If you choose to have a local anesthetic spray, the nurse will first make sure you do not:
   1. Have any allergies
   2. You are not taking any medication that would cause this to be a problem.
7. The nurse will pull the sponge up with the string. This will only take 1 or 2 seconds and should not be painful. You will be aware of a tugging sensation in your chest and back of your throat. You may also feel like the inside of your food pipe is being brushed. The sponge collects cells as it passes through. This at times can cause a ‘gagging’ reflex which is entirely normal for this type of procedure.
8. After your test, the sample will be sent to the laboratory where it will be reviewed, and findings reported back.

After your procedure

You will be allowed to leave the department unaccompanied shortly after the procedure.

• If you have had a local anaesthetic spray, this causes a numbing in your throat which will soon go away. For safety reasons you will be advised not to eat or drink for 60 minutes, until your throat feels back to normal.
• If you have a sore throat one hour after the test, you can take a throat lozenge or over the counter painkiller such Paracetamol, if required.
• If your heartburn symptoms become worse, you should continue to take heartburn medication as prescribed.

Risks and side-effects

The capsule sponge test has not been found to have any serious side effects. Most people do not have any problem swallowing the capsule however, if you are unable to, we will not continue with the test. You may have a mild sore throat which might last up to 48 hours after the test.

There is a small risk (fewer than 1 in 1000) that the string may become detached from the sponge, or it may be difficult to remove the sponge. If this happens it is not painful or dangerous.

However, you will need an endoscopy procedure to remove the sponge. This would need to be carried out on the same day and would be arranged at the local hospital endoscopy department.

There is a small chance that you may experience post procedural bleeding. This is why it is important to let us know before the procedure if you are taking any blood thinning medication (anticoagulant or antiplatelet).

If you bring up different colour sputum (pink or red) or experience vomiting fresh blood, please contact the clinic using the contact details on this letter and attend the emergency department (A&E) or call 999.

Capsule sponge test alternatives

Further investigations, such as endoscopy procedure, may be offered depending on the capsule sponge test results. You will be informed about these alternatives based on your test findings.

Do you have any further questions?

This leaflet provides information about the procedure and what you can expect, we want patients to feel at ease with the procedure. If after reading this leaflet you have any further questions or have any additional support requirements, please contact our team.