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Cytosponge: Trailblazer for Barrett's Oesophagus?

When you fall off the wagon from your healthy diet or habitually consume food that trigger heartburn or indigestion, acid reflux may be a common occurrence. However, stomach acid backing up your food pipe is never a pleasant experience. If this happens often, and you’re having difficulty swallowing food, it may be best to check with your GP for Barrett’s oesophagus.

Barrett’s oesophagus [1] may start as a benign condition where the squamous cells lining the inside of your throat have changed in shape. Under normal circumstances, these cells would appear flat under a microscope. If they are growing abnormally, i.e. when they become columnar, doctors will assess whether the abnormality is on the low-grade or high-grade range.

This condition can be managed with medicine, thereby enabling afflicted patients to lead normal lives. People with low-grade Barrett’s oesophagus can be treated by prescribed drug called proton pump inhibitors such as omeprazole tablets, which may reduce the production of stomach acid. [2] For higher grade cases, more intensive treatments are recommended such as en bloc esophagectomy. [3]

Recent studies show that about 5 out of 100 people with Barrett’s oesophagus develop cancer of the oesophagus. [4] Presently, it would require a biopsy to diagnose both conditions. A trained specialist may have to evaluate the mutations in the cells further if they happen to be cancerous or not. The sample tissue may not have been gathered from the targeted area, which consequently lessens the chance of a standard biopsy being fool-proof.

Endoscopy is a more routine way to screen for Barrett’s oesophagus and oesophageal cancer. It is a test using a tiny camera attached to a long, malleable tube that goes into the mouth, to the throat all the way to the stomach and even as further down to the colon, depending on what the doctor needs to look at. Endoscopy checks for any growths or abnormalities in the aforementioned organs. [5]

However, this process is not without a few risks. Common side effects include bloating, discomfort due to air being pumped into the stomach during the test, sore throat and sometimes bruising of the oesophagus’ lining as the tube passes along it. This would explain why some patients, especially those prone to heartburn and indigestion, are wary of undergoing endoscopy.

A team of scientists from the Medical Research Council Cancer Unit at the University of Cambridge carried out genome sequencing to compare the mutations of Barett’s oesophagus and oesophageal cancer. Out of this research came the Cytosponge, developed by Professor Rebecca Fitzgerald from the same team. [6]

Cytosponge is a tiny mesh sponge encased in a soluble capsule about 2 cm in height, attached to a string. [7] While hanging on to the thin thread, the patient can swallow it with water just like a normal pill. The gelatin casing will dissolve as the cytosponge makes it way down the throat. The sponge then expands as it reaches the stomach. After five minutes, the doctor or health practitioner conducting the test will make use of the string to retrieve the slightly coarse sponge that has collected cell samples along the oesophagus. For a visual presentation explaining how the cytosponge works inside the body, you may refer to the video found in the link: https://www.youtube.com/watch?v=iGqBu4C2ASg [8]

So is the cytosponge a preferable screening method over the more invasive and more costly endoscopy? A study was conducted involving 97 participants, 43 of which have Barrett’s oesophagus. [9] 80% of the patients with the pre-existing condition have stated they would choose the sponge method over endoscopy. They did not experience any complications, either. So far, the participants are able to swallow the pill without difficulty. The sponges that underwent the trials gathered discernible cells that had proved to be ample enough for assessment. The “pill on a string” is applicable to primary care, although the technique may require further fine tuning to increase specificity and sensitivity of the test itself.

The research was funded by the Medical Research Council and Cancer Research UK and licensed under Medtronic GI Solutions.[7] While clinical trials are still ongoing, the cytosponge is not commercially available worldwide just yet. It has acquired a CE marking ("Conformité Européene" or "European Conformity") to be distributed in Europe [10] and the Food and Drug Administration (FDA) Approval in the United States [11]. No certain dates have been announced when the cytosponge would be available in the UK and United States just yet.

Since the cytosponge is more acceptable and less invasive, this may encourage more patients with prevalent symptoms to get tested for Barrett’s oesophagus. The benefits of choosing this route compared to an endoscopic screening include less wait time and costs, no sedation necessary, and minimal discomfort. Early detection is key for prevention of any type of cancer. If Barrett’s oesophagus is caught and treated at its early stages, then the chances of it escalating to oesophageal cancer may be greatly preventable. With this said, it is with great hope that cytosponge may pave the way for the development of less complicated, more cost-effective and more accessible methods of screening for different types of cancer in the future.

by APBN writer, Catherine Domingo Ong
Catherine is a writer whose guilty pleasure is lounging in a peaceful location with a good book (or several) and a latte at hand.
  1. Barrett’s oesophagus, https://beta-about-cancer.cancerresearchuk.org/about-cancer/oesophageal-cancer/about-oesophageal-cancer/causes-risks/barretts-oesophagus/
  2. Treatment for Barrett’s oesophagus, https://beta-about-cancer.cancerresearchuk.org/about-cancer/oesophageal-cancer/about-oesophageal-cancer/causes-risks/barretts-oesophagus/treatment-barretts-oesophagus/
  3. Barrett's esophagus with high-grade dysplasia: Focus on current treatment options, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208361/
  4. ‘Pill on a string’ could help spot early signs of cancer of the gullet, https://www.cam.ac.uk/research/news/pill-on-a-string-could-help-spot-early-signs-of-cancer-of-the-gullet
  5. Endoscopy, https://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/endoscopy
  6. Caryn S. Ross-Innes et al, Whole-genome sequencing provides new insights into the clonal architecture of Barrett’s esophagus and esophageal adenocarcinoma, Nature Genetics 47, 1038–1046 (2015) doi:10.1038/ng.3357, https://www.nature.com/ng/journal/v47/n9/full/ng.3357.html
  7. The Cytosponge: An Alternative to Endoscopy in Detecting Barrett Esophagus, https://www.cadth.ca/cytosponge-alternative-endoscopy-detecting-barrett-esophagus
  8. Cytosponge - Early detection for oesophageal cancer: https://www.youtube.com/watch?v=iGqBu4C2ASg
  9. Pierre Lao-Siriex et al., Non-endoscopic immunocytological screening test for Barrett's oesophagus, Gut. 2007 Jul; 56(7): 1033–1034. doi: 10.1136/gut.2007.123257, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994353/
  10. Reviewing translation at the MRC London (UK): MRC Technology; 2014, https://www.mrctechnology.org/wp-content/uploads/2015/04/Reviewing-translation-at-the-MRC.pdf
  11. U.S. Food and Drug Administration. 510(k) premarket notification: esophagoscope (flexible or rigid) Silver Spring (MD): The Administration; 2015 Sep 14, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K142695

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