Goodbye to endoscopies? The capsule that could detect esophageal cancer in a less invasive way.

A recent study from the University of Cambridge , Addenbrooke's Hospital, and Queen Mary University of London has revealed that the capsule sponge test could replace endoscopies in up to half of patients with Barrett's esophagus, a precursor to esophageal cancer. This less invasive alternative could be administered by nurses and in primary care practices, easing the burden on National Health System (NHS) resources.

Esophageal cancer , known for its difficult treatment , has a five-year survival rate of less than 20% after diagnosis, a figure that has not changed significantly in the past three decades. At the same time, cases of this disease have increased fourfold since the 1970s.

Barrett's esophagus is a condition in which the cells lining the esophagus undergo changes that, over time, can lead to a precancerous condition called dysplasia . There are two types of dysplasia: low-grade, with a risk of developing esophageal cancer of about 10%, and high-grade, which doubles that risk, reaching 20%.

Barrett's esophagus is usually diagnosed after the onset of symptoms such as persistent heartburn, using an endoscopy, an invasive procedure that requires inserting a camera into the stomach. However, there are long waiting times for these tests in the NHS, and patients diagnosed with the condition must undergo periodic endoscopies throughout their lives, often 10 or more times.

The capsule sponge test

Professor Rebecca Fitzgerald , director of the Early Cancer Institute at the University of Cambridge, is leading research into the capsule-sponge test, which involves swallowing a pill connected to a string. This capsule dissolves in the stomach, releasing a sponge that, when withdrawn, collects some cells from the esophagus . The resulting samples are stained and analyzed for key markers that indicate an elevated cancer risk, such as the presence of alterations in the p53 protein and abnormal cells.

In a study published Tuesday in The Lancet , Fitzgerald's team investigated how the test could be used to stratify patients with Barrett's esophagus according to their risk of developing cancer. The study, which included 910 patients from 13 UK hospitals, showed that the capsule sponge test could classify patients into three groups: high risk , moderate risk , and low risk . Those in the low-risk group could be monitored without an endoscopy.

Fewer endoscopies, greater efficiency

The analysis revealed that 15% of patients were at high risk, with 38% of these at a precancerous stage . Fifty-four percent of patients were classified as low risk, and only 0.4% of them had high-grade dysplasia requiring follow-up. Using the capsule sponge test in these patients could avoid the need for frequent endoscopies and significantly reduce the burden on NHS resources.

Professor Peter Sasieni, of the Cancer Prevention Trials Unit at Queen Mary University , said the results suggested the capsule sponge could replace endoscopies in most low-risk patients, making it both more convenient for patients and more cost-effective for the health system.

More accessible and less invasive

The capsule sponge test not only has the potential to improve early cancer detection , but it's also more accessible. It can be administered by nurses with limited training, meaning it could be performed in primary care settings without the need for specialized equipment.

Michelle Mitchell , chief executive of Cancer Research UK, highlighted that this test represents one of the most promising advances in the early detection of esophageal cancer , which could save many lives. "If widely adopted, this less invasive alternative could prevent patients from undergoing uncomfortable and costly procedures, improving access to care in the community."

The study, supported by Cancer Research UK, Innovate UK, NHS England, and the Medical Research Council, suggests that the capsule sponge test could revolutionize the way Barrett's esophagus is diagnosed and monitored, improving both patient convenience and healthcare efficiency.

Duncan Cook , a patient who participated in the study, expressed his satisfaction with the test: "It's much better than going through endoscopies . The sponge test is quicker, you don't need sedation, and you can carry on with your normal life after the test."

This breakthrough could be a crucial step toward improving early detection of esophageal cancer , providing patients with a less invasive , more accessible, and much more convenient option.