在英格兰社区通过全科医生邀请和自我转诊使用移动单元提供胶囊海绵检测以筛查巴雷特食管：一项实施研究
Using a mobile unit to deliver capsule sponge testing for Barrett's oesophagus in the community in England through GP invitation and self-referral: an implementation study.
文献信息
| PMID | 42772946 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Rebecca Landy |
| 作者单位 | Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK rebecca.landy@cancer.org. |
| 期刊 | BMJ open gastroenterology |
| SCI 分区 | Q3 |
| IF | 3.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 为有胃食管反流症状的个体提供非内镜胶囊海绵检测，提高了巴雷特食管（BO）——食管腺癌的前驱病变——的检出率。然而，通过全科医生（GP）记录识别出的个体中仅有24%参与。因此，我们开展了一项实施研究，以评估在移动单元上进行筛查的可行性，以及GP邀请和自我转诊个体的筛查参与率。
方法： 在这项实施研究中，2021年6月至2023年1月期间，英格兰东部三个GP诊所的GP邀请了3293名年龄≥50岁且有重复质子泵抑制剂处方的个体参与。此外，我们宣传了该研究并允许自我转诊。根据年龄和反流史评估资格。符合条件的个体被邀请预约。预约后评估可接受性。胶囊海绵检测阳性的个体被转诊进行内镜检查。
结果： GP邀请的个体中有一半做出了回应，其中59.6%（n=952/1598）表示感兴趣。在能够联系到的感兴趣个体中，66.3%（n=574/866）符合条件，532人参与。其中，502人（94%）成功吞下胶囊海绵，占受邀者的15%，占符合条件者的87.5%。在468名能够联系到的自我转诊个体中，48.5%（n=227）符合条件，217人参与，208人（96%）成功吞下胶囊海绵（占自我转诊者的39.6%，占符合条件者的91.6%）。GP邀请者中9.4%（n=47/502）和自我转诊者中12.0%（n=25/208）被转诊进行内镜检查，分别有4.2%（n=21/502）和3.4%（n=7/208）被诊断为BO（内镜转诊的阳性预测值=42.4%），其中三例伴有异型增生。超过99%的参与者表示胶囊海绵检测是可接受的。
结论： 在移动单元上进行筛查是可行的。从GP记录中识别BO风险增加的个体是可行的，鼓励自我转诊可提高参与率。在符合条件且自我转诊的参与者与通过GP记录识别的参与者之间，BO患病率相似。
试验注册号： ISRCTN91655550。
英文摘要
OBJECTIVE: Offering individuals with gastro-oesophageal reflux a non-endoscopic capsule sponge test increased detection of Barrett's oesophagus (BO), a precursor to oesophageal adenocarcinoma. However, only 24% of individuals identified through general practitioner (GP) records participated. We therefore performed an implementation study to assess the feasibility of screening on a mobile unit and screening uptake among GP-invited and self-referred individuals.
METHODS: In this implementation study, 3293 individuals aged ≥50 with a repeat proton pump inhibitor prescription were invited to participate by their GPs across three GP practices in the East of England between June 2021 and January 2023. Additionally, we advertised the study and allowed self-referrals. Eligibility was assessed based on age and reflux history. Eligible individuals were invited to an appointment. Acceptability was assessed after the appointment. Individuals with a positive capsule sponge test were referred for endoscopy.
RESULTS: Half of the GP-invited individuals responded, of whom 59.6% (n=952/1598) were interested. Among interested individuals who could be contacted, 66.3% (n=574/866) were eligible, and 532 participated. Of these, 502 (94%) successfully swallowed a capsule sponge, representing 15% of those invited and 87.5% of eligible individuals. Among 468 individuals who self-referred and could be contacted, 48.5% (n=227) were eligible, 217 participated, and 208 (96%) successfully swallowed a capsule sponge (39.6% of self-referred, 91.6% of eligible individuals). 9.4% (n=47/502) of GP-invited and 12.0% (n=25/208) of self-referred individuals were referred for endoscopy, with 4.2% (n=21/502) and 3.4% (n=7/208), respectively, diagnosed with BO (positive predictive value of endoscopy referral=42.4%), including three with dysplasia. Over 99% of participants said the capsule sponge test was acceptable.
CONCLUSION: Screening on a mobile unit is feasible. Identifying individuals at increased risk of BO from GP records is feasible, and encouraging self-referrals increases uptake. BO prevalence was similar among eligible participants who self-referred and those identified through GP records.
TRIAL REGISTRATION NUMBER: ISRCTN91655550.