'Sponge on a string' test improves Barrett's oesophagus, early cancer diagnosis: study

A study published Friday in The Lancet suggests that in patients with gastro-oesophageal reflux, testing with Cytosponge-trefoil factor 3 (TFF3), a non-endoscopic cell collection device referred to as a "sponge on a string," resulted in a 10-fold improvement in the detection of Barrett's oesophagus compared with standard management. Cytosponge also improved the detection of early oesophageal cancer.

"It's taken almost a decade of research and testing thousands of patients to show that we've developed a better route to diagnosing Barrett's oesophagus," said study lead Rebecca Fitzgerald, adding "the sponge could also be a game-changer in how we diagnose and ensure more people survive oesophageal cancer." She noted that "compared with endoscopies performed in hospital, the Cytosponge causes minimal discomfort and is a quick, simple test that can be done by a GP." The test is already being piloted around the UK.

Pill expands into small sponge

The Cytosponge test, developed at the University of Cambridge, is a small pill attached to a thread that the patient swallows. The pill expands into a small sponge when it reaches the stomach and is quickly pulled back up the throat by a nurse, collecting cells from the oesophagus for analysis using the laboratory marker TFF3.

The BEST3 study included 13,222 participants who were randomly allocated to the sponge test or usual care. Over the course of a year, Barrett's oesophagus was diagnosed in 140 patients in the Cytosponge group and in 13 patients who received usual care. Additionally, the Cytosponge diagnosed five cases of stage 1 or 2 cancer, whereas only one case of early oesophageal cancer was detected in the group receiving usual care.

Economic evaluation

The researchers are currently completing an "economic evaluation" of the Cytosponge test and hope that it will be rolled out within GP practices within three to five years.

Peter Sasieni, whose King's College London team have been leading the clinical evaluation of the Cytosponge over the last decade, said "the results of this trial exceeded my most optimistic expectations." He added that "this trial found that both patients and staff were happy with the Cytosponge test and it is practical to consider rolling it out within the NHS."

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