Cytosponge in screening for Barrett's oesophagus

Cytosponge in screening for Barrett’s oesophagus

• Cytosponge is a non-endoscopic diagnostic tool that was developed to detect Barrett's oesophagus in patients with reflux symptoms
  
  • consists of a tethered capsule that is swallowed in a primary or secondary care office setting and collects oesophageal cells, which can be assessed for morphology and immunohistochemical biomarkers of intestinal metaplasia (TFF3) and dysplasia (atypia and p53) (1)
    
• non-endoscopic oesophageal cell collection device known as the Cytosponge, coupled with a biomarker test for trefoil factor 3 (TFF3), has been shown to increase detection of Barrett's oesophagus ten times over the current standard of care (2)
  
• the BEST3 study (3):
  • in patients with gastro-oesophageal reflux, the offer of Cytosponge-TFF3 testing resulted in improved detection of Barrett's oesophagus

A large‐scale real‐world NHS evaluation showed that capsule sponge is feasible as a nurse‐led triage service for patients with reflux symptoms on routine/low‐risk endoscopy waiting lists (4):

• the capsule sponge pathway led to 78% discharge rate from endoscopy and had high patient acceptability, despite leading to longer clinical pathways for 22% requiring endoscopy
• among patients who attended capsule sponge visits, 95% of patients had successfully completed the test, and 87% patients required only one attempt

Schematic illustration of the capsule sponge procedure (4)

• the procedure is carried out in a nurse‐led clinic, where the patient is consented
• patient swallows the capsule/pill with water while the nurse holds the other end
• after 5–7 min, after the pill has dissolved thanks to the gastric juices and the sponge has fully expanded, the nurse pulls the sponge out
  • allows for pan‐oesophageal cell collection, which is then taken to the laboratory taken to the laboratory for IHC staining for TFF3, marker of intestinal metaplasia, H&E and IHC for atypia and p53
• whole procedure takes around 10 min to complete

Open Image in Modal

Reference:

1. di Pietro M, Modolell I, O'Donovan M, Price C, Pilonis ND, Debiram-Beecham I, Fitzgerald RC. Use of Cytosponge as a triaging tool to upper gastrointestinal endoscopy during the COVID-19 pandemic. Lancet Gastroenterol Hepatol. 2020 Sep;5(9):805-806. doi: 10.1016/S2468-1253(20)30242-9.
2. Pilonis ND, Killcoyne S, Tan WK, O'Donovan M, Malhotra S, Tripathi M, Miremadi A, Debiram-Beecham I, Evans T, Phillips R, Morris DL, Vickery C, Harrison J, di Pietro M, Ortiz-Fernandez-Sordo J, Haidry R, Kerridge A, Sasieni PD, Fitzgerald RC. Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot. Lancet Oncol. 2022 Feb;23(2):270-278.
3. Fitzgerald RC, di Pietro M, O'Donovan M, Maroni R, Muldrew B, Debiram-Beecham I, Gehrung M, Offman J, Tripathi M, Smith SG, Aigret B, Walter FM, Rubin G; BEST3 Trial team; Sasieni P. Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial. Lancet. 2020 Aug 1;396(10247):333-344
4. Gourgiotis V, Graham C, Foerster K; NHS England Pilot and NHS England Oversight Group; Fitzgerald RC, Harvey R, Morris DL. Use of a Non-Endoscopic Capsule-Sponge Triage Test for Reflux Symptoms: Results From the NHS England Prospective Real-World Evaluation. Aliment Pharmacol Ther. 2025 Mar;61(5):876-885.