Discussion
Barrett’s oesophagus, anxiety
REGRESSION
The Cytosponge test is a safe and well tolerated method to screen for Barrett’s oesophagus that can be carried out in a primary care setting. The vast majority of BEST3 participants had a positive experience: the overall median IAPS score was 1.7 and only 4.7% had a score above 2.5. This study has given some insights into the factors that need attention to further improve the experience of patients undergoing the Cytosponge procedure. In adjusted analyses, anxiety and a failed swallow at first attempt were found to be strongly associated with the least positive experience, in addition to sex, height, alcohol intake and education level. A multivariable regression analysis did not identify any statistically significant predictors of unsuccessful swallow.Around one third of the study cohort had high or very high anxiety scores just prior to the procedure and the adjusted odds of the least positive experience were 3–4 times higher in these groups than in those with low/normal anxiety levels. As the STAI-6 used to measure anxiety prior to the Cytosponge procedure did not specifically ask about the procedure, it is not clear whether these individuals felt anxious in general or about the procedure specifically. It may be that people who find swallowing tablets difficult, or the Cytosponge retrieval procedure particularly aversive, were more anxious about the procedure and also reported a less positive experience afterwards. It is also possible that people suffering from anxiety for reasons unrelated to the procedure were inclined to rate the experience more negatively. 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 overall experience.Secondly, having a failed swallow at first attempt was also a strong predictor of the least positive patient experience. As this is potentially modifiable, we attempted to identify predictors for it. However, when running a multivariable regression with backwards selection for unsuccessful swallow, none of the variables were significant predictors. Changes to the amount of water or way that water is offered (e.g. from a cup or with a straw) might reduce the risk of failed swallow attempts and could be tested in the future.Drinking alcohol daily was associated with increased odds of having a less positive experience. According to some studies, alcohol consumption is directly related to increased symptoms of GORD [The participants with education from college or vocational school and school up to 15–16 years of age were less likely to have a negative experience as compared to those who were university educated; however, the test for a trend only reached borderline statistical significance. This finding is in line with past studies suggesting that a higher level of patient satisfaction is associated with lower educational level in outpatient care [