{
  "abstract": "Background UK endoscopy services face sustained and escalating capacity pressures, leading to extensive waiting periods for routine diagnostic procedures. Lower faecal immunochemical test (FIT) thresholds within the Bowel Cancer Screening Programme (BCSP) are projected to increase the already rising annual demand, compounding existing diagnostic backlogs. Under such pressures, endoscopy units face increasing reliance on outsourcing, reduced procedure times, and risks to quality. Capsule sponge offers a minimally invasive alternative to oesophagogastroduodenoscopy (OGD) for selected low-risk referrals. We modelled the potential system-level impact of integrating capsule sponge into an NHS endoscopy pathway.Methods A Python-based discrete event simulation model compared the baseline endoscopy pathway in an NHS hospital with clinically informed scenarios in which a proportion of low-risk OGD referrals were replaced by capsule sponge. Endoscopy pathways were categorised as routine, intermediate or high risk, encompassing diagnostic and therapeutic procedures. Real-world data-informed referral volumes, procedure mix, staffing, and room capacity. The model was calibrated to observed service throughput. Outcomes included released capacity, waiting times, and alternative applications of released endoscopy time.Results Over one year, 23,683 endoscopic procedures were undertaken, of which 85.6% were diagnostic and 12.67% therapeutic. Modelling the Introduction of capsule sponge to replace 15% and 25% based on NHS pilot data of routine diagnostic OGDs released 978 (4.8%) and 1,863 (9.2%) increases in diagnostic throughput equivalent to 25,587, and 42,640 minutes of additional endoscopy capacity, respectively. Mean waiting times for diagnostic endoscopy were reduced by 3.2 and 6.3 days across the two scenarios. Alternative use of this capacity allowed extension of diagnostic procedure duration by 1.5 and 2.76 minutes, a 5.02% and 9.24% increases relative to the mean diagnostic procedure duration, which can support quality improvement. As a further strategy (not evaluated), released capacity could be used to reduce outsourcing, generating substantial cost savings in the modelled department. Higher-risk and therapeutic pathways were unaffected.Conclusions With sustained growth in endoscopy demand, services face mounting risks to access, quality and cost-efficiency. Substituting capsule sponge for a defined proportion of low-risk upper gastrointestinal endoscopies can release clinically significant endoscopy capacity without additional workforce or infrastructure.",
  "authors": [
    {
      "affiliations": [
        "University of Leeds, Leeds, United Kingdom"
      ],
      "name": "Ramzi Fayad"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, United Kingdom"
      ],
      "name": "Armando Vargas-Palacios"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, United Kingdom",
        "Leeds Cancer Centre, Leeds Teaching Hospital, Leeds, United Kingdom"
      ],
      "name": "Katie Spencer"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Cambridge University Hospitals, Cambridge, United Kingdom",
        "Early Cancer Institute, Hutchison Research Centre, University of Cambridge, Cambridge, United Kingdom"
      ],
      "name": "Andreas V Hadjinicolaou"
    },
    {
      "affiliations": [
        "Early Cancer Institute, Hutchison Research Centre, University of Cambridge, Cambridge, United Kingdom"
      ],
      "name": "Rebecca Fitzgerald"
    }
  ],
  "title": "P25 Assessing the impact of capsule sponge integration on NHS endoscopy capacity: a discrete event simulation study",
  "uid": "d85fd2d4-fffa-5491-86ee-d01eab2ceb10"
}