Endoscopies are commonly used to determine esophageal cancer risk, but a test involving a “pill-on-a-thread” has shown promise as an easier alternative for some patients. Those with Barrett’s esophagus — a risk factor for esophageal cancer — often need to undergo multiple endoscopies, in which a long tube with a camera is passed down into the stomach.
Although it’s crucial to monitor the esophagus over time, endoscopies can end up being uncomfortable for patients, who may also experience long wait times for the procedure. A new study published in The Lancet has shown that a less invasive capsule sponge test could replace endoscopies for half of all patients with Barrett's esophagus.
Monitoring Esophageal Cancer Risk
Esophageal cancer is a rare form of cancer, making up just 1 percent of all cancers diagnosed in the U.S. However, this cancer is also difficult to treat and has high mortality rates, with fewer than one in five patients surviving five or more years following diagnosis.
Those with Barrett’s esophagus — which causes the tissue along the esophagus to become more like intestinal tissue — run a slight risk of developing dysplasia, a pre-cancerous state.
Barrett’s esophagus is often associated with symptoms like persistent heartburn and regurgitation. Patients with the condition undergo endoscopies to look for dysplasia, which can be low-grade or high-grade. The low-grade version is linked with a one in 10 chance of developing esophageal cancer, while the high-grade version increases to a one in five chance.
Continued monitoring of the esophagus is vital, as catching dysplasia early can potentially avert cancer development. Doctors have mostly relied on endoscopies to keep track of any changes.
“But the chances of Barrett’s progressing to cancer are low, and endoscopies are not very pleasant procedures,” said Rebecca Fitzgerald, Director of the Early Cancer Institute at the University of Cambridge, in a statement. “Added to that, endoscopies are not always a reliable way of spotting early cancers and can depend on the skill of the person doing the endoscopy and the equipment being used. What we need is an alternative surveillance method that’s less invasive, easier to administer, and more reliable.”
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How the Pill-on-a-Thread Works
Researchers have been working on a capsule sponge test to reduce the strain from endoscopies on both patients and resources. For this test, a patient swallows a pill connected to a thread. The pill dissolves once it is in the stomach. When fully dissolved, it releases a sponge that scrapes cells for testing as it comes back up the esophagus.
Samples from the test are stained with a chemical and examined under a microscope to look for two markers: abnormalities in p53 — a protein that suppresses tumors — and cells that appear abnormal, called “atypia”.
The new study used the capsule sponge test to see how it could effectively classify esophageal cancer risk. Researchers recruited 910 patients from 13 hospitals across the U.K., all of whom were already diagnosed with Barrett’s esophagus.
The patients were then given the test and assigned to one of three categories based on the results: high risk (with one or both markers), moderate risk (with no markers but other risk factors related to age and sex), and low risk (with no markers or other risk factors). All patients also had endoscopies performed to compare with the capsule sponge tests.
Benefits of the Capsule Sponge Test
The tests classified 15 percent of patients at high risk, meaning they had abnormal p53 and/or atypia. Additionally, 38 percent of these patients were found to be at a pre-cancerous stage.
Over half of the patients (54 percent) were classified as low risk. According to endoscopy results, only two of the 495 patients in this category (0.4 percent) had a high-grade dysplasia that required follow-up testing.
While those at high risk would need to continue monitoring with endoscopies, it would likely be safe for those at low risk to continue monitoring with the capsule sponge test. The researchers say that the sponge capsule test would not only free up endoscopy resources but also make monitoring more comfortable for patients.
A 57-year-old man, Duncan Cook, who participated in the research and had undergone endoscopies for nearly 20 years to monitor his Barrett's esophagus, shared his positive experience with the test.
“The first time I had the sponge, I was a bit nervous,” Cook said in the statement. “It’s quite a big pill to swallow, but it’s much better than going for endoscopies. The sponge test is faster, you don’t need sedation for it, and you don’t need to find someone to come with you to drive you home after. I was able to have the test done and go right back to work after.”
This article is not offering medical advice and should be used for informational purposes only.
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Article Sources
Our writers at Discovermagazine.com use peer-reviewed studies and high-quality sources for our articles, and our editors review for scientific accuracy and editorial standards. Review the sources used below for this article:
American Cancer Society. Key Statistics for Esophageal Cancer
NIH. Barrett’s Esophagus.
Cancer Research U.K. Capsule sponge testing and oesophageal cancer diagnosis
Jack Knudson is an assistant editor at Discover with a strong interest in environmental science and history. Before joining Discover in 2023, he studied journalism at the Scripps College of Communication at Ohio University and previously interned at Recycling Today magazine.
