cytosponge in screening for Barrett's oesophagus

Last edited 05/2023 and last reviewed 08/2023

Cytosponge

  • 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 is summarised (3):
    • patients were randomly assigned (per practice or at the individual patient level) to the usual care group or the intervention group
      • in the intervention group
        • 2679 (39%) expressed an interest in undergoing the Cytosponge-TFF3 procedure
          • of these, 1750 (65%) met all of the eligibility criteria on telephone screening and underwent the procedure
          • most of these participants (1654 [95%]; median age 69 years) swallowed the Cytosponge successfully and produced a sample
          • 231 (3%) of 6834 participants had a positive Cytosponge-TFF3 result and were referred for an endoscopy
          • patients who declined the offer of the Cytosponge-TFF3 procedure and all participants in the usual care group only had an endoscopy if deemed necessary by their general practitioner
          • during an average of 12 months of follow-up, 140 (2%) of 6834 participants in the intervention group and 13 (<1%) of 6388 participants in the usual care group were diagnosed with Barrett's oesophagus
          • nine (<1%) of 6834 participants were diagnosed with dysplastic Barrett's oesophagus (n=4) or stage I oesophago-gastric cancer (n=5) in the intervention group, whereas no participants were diagnosed with dysplastic Barrett's oesophagus or stage I gastro-oesophageal junction cancer in the usual care group
          • among 1654 participants in the intervention group who swallowed the Cytosponge device successfully, 221 (13%) underwent endoscopy after testing positive for TFF3 and 131 (8%, corresponding to 59% of those having an endoscopy) were diagnosed with Barrett's oesophagus or cancer.
          • one patient had a detachment of the Cytosponge from the thread requiring endoscopic removal, and the most common side-effect was a sore throat in 63 (4%) of 1654 participants
    • the study authors concluded that:
      • in patients with gastro-oesophageal reflux, the offer of Cytosponge-TFF3 testing results in improved detection of Barrett's oesophagus

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