Evaluating an alternative surveillance method for esophageal cancer
A novel capsule sponge test could replace endoscopy for monitoring Barrett’s esophagus.
Barrett’s esophagus – a known precursor to esophageal cancer – is typically monitored by endoscopy. Yet these procedures can be invasive, expensive and have long wait times. Now, researchers at the University of Cambridge (UK) have developed a far less invasive, and easier-to-administer, capsule sponge test that could replace endoscopies for half of all patients being monitored for esophageal cancer.
Barrett’s esophagus is characterized by changes in the shape and structure of cells lining the esophagus. While the risk of esophageal cancer progression from non-dysplastic Barrett’s esophagus is low, over time, these cells can develop into a pre-cancerous state known as dysplasia, increasing the risk of progression. Patients with low-grade dysplasia have a roughly one in ten chance of developing esophageal cancer; however, this risk doubles for patients with high-grade dysplasia.
For patients diagnosed with Barrett’s esophagus, regular endoscopic surveillance is the clinical standard for monitoring dysplasia or early cancer. “…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,” commented corresponding author Rebecca Fitzgerald.
Recently, Fitzgerald and colleagues developed a capsule sponge test coupled with biomarkers, with the potential to replace the endoscope. This test works by patients swallowing a pill connected to a thread. In the stomach, the pill dissolves to release a sponge. When the sponge is drawn back up, cells in the esophagus are lightly scraped off, which can then be examined by pathologists.
Previously, the researchers focused their test on diagnosing Barrett’s esophagus, but now, they have evaluated their test as an alternative surveillance method for monitoring Barrett’s esophagus more effectively.
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To do this, the researchers recruited 910 patients from 13 hospitals across the UK who had been diagnosed with Barrett’s esophagus and were undergoing endoscopic surveillance. These patients were administered the capsule test and stratified to one of three groups based on the results – high risk, moderate risk or low risk. The patients then received an endoscopy in order to compare the results with those from the capsule sponge test.
The results revealed that 15% were classified as high risk, 31% as moderate risk and 54% as low risk, with the endoscope revealing that only 0.4% of the low-risk group actually had a high-grade dysplasia.
“Our findings suggest that the capsule sponge could help stratify patients with Barrett’s esophagus by risk and that half of them will fall into the low-risk group. Given that the risk of these individuals progressing to dysplasia and then to esophageal cancer is so low, it should be safe to replace their usual endoscopy with the capsule sponge,” stated co-author Peter Sasieni (Queen Mary University of London, UK).